Provider Demographics
NPI:1003480039
Name:MILLER, KELSEY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:MILLER
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:DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
Mailing Address - Street 2:CAMPUS BOX #7525, BRINKHOUS-BULLITT BUILDING
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7525
Mailing Address - Country:US
Mailing Address - Phone:919-966-4676
Mailing Address - Fax:919-966-6718
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-7836
Practice Address - Fax:984-974-0290
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRTL21-0106390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program