Healthcare Provider Details

I. General information

NPI: 1346416948
Provider Name (Legal Business Name): KELLY ALLAN SCHOFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 04/30/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 W NC HIGHWAY 54 DURHAM
DURHAM NC
27707-5511
US

IV. Provider business mailing address

1603 W NC HIGHWAY 54
DURHAM NC
27707-5511
US

V. Phone/Fax

Practice location:
  • Phone: 919-443-2341
  • Fax: 919-869-1678
Mailing address:
  • Phone: 919-275-2845
  • Fax: 833-740-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2012-02176
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberNC2012-02176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: