Healthcare Provider Details

I. General information

NPI: 1417234626
Provider Name (Legal Business Name): VANESSA LYNN KELKAR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 YORK RD SUITE 100
TOWSON MD
21204-7532
US

IV. Provider business mailing address

7402 YORK RD SUITE 100
TOWSON MD
21204-7532
US

V. Phone/Fax

Practice location:
  • Phone: 410-494-1846
  • Fax: 410-828-1706
Mailing address:
  • Phone: 410-494-1846
  • Fax: 410-828-1706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR139449
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: