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General NPI Number Information
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NPI Number | 1104838887
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Entity Type | Individual
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Provider Name | KELLY MAEDO M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 3100 BUDDY OWENS AVE
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City | MCALLEN
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State | TX
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Zip | 78504-6464
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Country | US
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Telephone | 956-971-0404
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Fax | 956-971-0408
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Provider Business Mailing Address
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Address Line | 818 ROYAL ADELADE DR
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City | COLLEGE STATION
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State | TX
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Zip | 77845-4444
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Country | US
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Telephone | 979-757-1103
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | L5032
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L5032
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License Number State | TX
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