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General NPI Number Information
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NPI Number | 1932100153
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Entity Type | Individual
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Provider Name | KELLY L. GEOGHAN D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 1447 YORK ROAD SUITE 504
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City | LUTHERVILLE
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State | MD
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Zip | 21093-6097
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Country | US
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Telephone | 410-753-4422
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Fax | 410-753-4660
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Provider Business Mailing Address
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Address Line | 1447 YORK ROAD SUITE 504
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City | LUTHERVILLE
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State | MD
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Zip | 21093-6097
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Country | US
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Telephone | 410-753-4422
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Fax | 410-753-4660
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 01285
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License Number State | MD
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