Healthcare Provider Details

I. General information

NPI: 1639521966
Provider Name (Legal Business Name): KATHRYN D. KELLY, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOCKWOOD DR SUITE 210
SILVER SPRING MD
20901-1556
US

IV. Provider business mailing address

10801 LOCKWOOD DR SUITE 210
SILVER SPRING MD
20901-1556
US

V. Phone/Fax

Practice location:
  • Phone: 301-298-1040
  • Fax: 844-288-6896
Mailing address:
  • Phone: 301-298-1040
  • Fax: 844-288-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0076087
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHRYN DELORES GARRETT KELLY
Title or Position: OWNER
Credential: MD
Phone: 202-549-9557