Healthcare Provider Details

I. General information

NPI: 1225437775
Provider Name (Legal Business Name): DR. PATRICK KELLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PATRICK KELLEY MD

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 KIMBERLY RD
SILVER SPRING MD
20903-1221
US

IV. Provider business mailing address

1935 KIMBERLY RD
SILVER SPRING MD
20903-1221
US

V. Phone/Fax

Practice location:
  • Phone: 301-445-0543
  • Fax:
Mailing address:
  • Phone: 301-445-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberD0029631
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: