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General NPI Number Information
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NPI Number | 1851435408
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Entity Type | Individual
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Provider Name | KELLEY BANAGAN MD
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Gender | Female
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 96 JONATHAN LUCAS STREET CSB 708 MSC 622
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City | CHARLESTON
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State | SC
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Zip | 29425-1544
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Country | US
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Telephone | 843-792-8105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 751461
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City | CHARLOTTE
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State | NC
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Zip | 28275-1461
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Country | US
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Telephone |
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | D72819
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | MD93962
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License Number State | SC
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