Healthcare Provider Details

I. General information

NPI: 1376781443
Provider Name (Legal Business Name): WILLIAM KING KELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 COLUMBIA PIKE STE 501
SILVER SPRING MD
20901-4460
US

IV. Provider business mailing address

4801 CONNECTICUT AVE NW APT 516
WASHINGTON DC
20008-2204
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-9035
  • Fax: 301-593-9036
Mailing address:
  • Phone: 202-286-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD39979
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number18454
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD39979
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: