Provider Demographics
NPI:1083396048
Name:KOOREY, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KOOREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2642
Mailing Address - Country:US
Mailing Address - Phone:301-633-7920
Mailing Address - Fax:
Practice Address - Street 1:2002 MEDICAL PKWY STE 250
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3279
Practice Address - Country:US
Practice Address - Phone:443-481-4016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator