Provider Demographics
NPI:1003298647
Name:MCDILL, KELSEY KLOSTERMEYER (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:KLOSTERMEYER
Last Name:MCDILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4341
Mailing Address - Country:US
Mailing Address - Phone:803-788-6146
Mailing Address - Fax:803-462-0312
Practice Address - Street 1:121 BLYTHEWOOD RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8426
Practice Address - Country:US
Practice Address - Phone:803-788-6360
Practice Address - Fax:803-462-0312
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL38204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics