Healthcare Provider Details

I. General information

NPI: 1164552865
Provider Name (Legal Business Name): CHRISTOPHER RYAN KELSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MORRIS BUILDING, SCIENCE DRIVE, ROOM 05135
DURHAM NC
27710-0001
US

IV. Provider business mailing address

PO BOX 3085
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-668-5213
  • Fax: 919-668-7345
Mailing address:
  • Phone: 919-668-5213
  • Fax: 919-668-7345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: