Healthcare Provider Details

I. General information

NPI: 1801871108
Provider Name (Legal Business Name): CHERYL ANN KELLERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 CORDATA PKWY
BELLINGHAM WA
98226-7123
US

IV. Provider business mailing address

PO BOX 5096
BELLINGHAM WA
98227-5096
US

V. Phone/Fax

Practice location:
  • Phone: 360-738-2200
  • Fax: 360-752-5282
Mailing address:
  • Phone: 360-738-2200
  • Fax: 360-752-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA397180
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA397180
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60054703
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: