MEDICARE: DR. KELLY G KILCOYNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	D75966	MD
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	D75966	MD
3	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1467650077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY G KILCOYNE M.D.

Provider Business Mailing Address
First Line	:	127 LUBRANO DR STE 202
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7369
Country	:	US
Telephone Number	:	410-544-4263
Fax Number	:	855-394-3899

Provider Business Practice Location Address
First Line	:	127 LUBRANO DR STE 202
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7369
Country	:	US
Telephone Number	:	410-544-4263
Fax Number	:	855-394-3899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	02/05/2025

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