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NPI Code Detail

MEDICARE: MARY CATHERINE KELLY CRNP

MEDICARE: MARY CATHERINE KELLY CRNP
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
1363L00000XNurse PractitionerR028542MD

General Provider Information

NPI Number : 1972653095
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CATHERINE KELLY CRNP
Provider Business Mailing Address
First Line : PO BOX 62026
Second Line :
City : BALTIMORE
State : MD
Zip : 21264-2026
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2525 POT SPRING RD
Second Line :
City : LUTHERVILLE TIMONIUM
State : MD
Zip : 21093-2778
Country : US
Telephone Number : 410-561-0200
Fax Number : 410-561-0400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2007
Last Update Date : 07/08/2007

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