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General NPI Number Information
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NPI Number | 1740415884
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Entity Type | Individual
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Provider Name | KEVIN P. KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 1501 DIVISION ST
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City | BALTIMORE
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State | MD
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Zip | 21217-3121
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Country | US
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Telephone | 410-728-5399
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Fax |
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Provider Business Mailing Address
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Address Line | 2641 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21218-4514
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Country | US
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Telephone | 410-466-5325
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Fax | 410-366-9533
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0043878
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License Number State | MD
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