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General NPI Number Information
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NPI Number | 1093344889
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Entity Type | Individual
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Provider Name | KELLY PHAN VAN DO
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Gender | Female
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 546 WINTER ST STE 100
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City | WOOSTER
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State | OH
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Zip | 44691-2339
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Country | US
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Telephone | 330-202-5662
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Fax | 330-202-5663
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Provider Business Mailing Address
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Address Line | 546 WINTER ST STE 100
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City | WOOSTER
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State | OH
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Zip | 44691-2339
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Country | US
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Telephone | 330-202-5662
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Fax | 330-202-5663
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 34.018222
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License Number State | OH
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