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General NPI Number Information
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NPI Number | 1144254814
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Entity Type | Individual
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Provider Name | KAMILAH MICHELLE KELLY MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 7377 WASHINGTON BLVD SUITE 101
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City | ELKRIDGE
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State | MD
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Zip | 21075-6360
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Country | US
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Telephone | 410-379-3051
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Fax | 410-379-3074
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Provider Business Mailing Address
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Address Line | 7377 WASHINGTON BLVD CONCENTRA MEDICAL CENTER
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City | ELKRIDGE
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State | MD
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Zip | 21075-6360
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Country | US
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Telephone | 410-379-3051
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Fax | 410-379-3074
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | D0062823
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License Number State | MD
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