Provider Demographics
NPI:1467466656
Name:RUSSO, KELLY SIPE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SIPE
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:1 HARRY TRUMAN PARKWAY
Mailing Address - Street 2:MS 3102
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-222-4114
Mailing Address - Fax:
Practice Address - Street 1:1 HARRY S TRUMAN PKWY
Practice Address - Street 2:MS 3102
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7037
Practice Address - Country:US
Practice Address - Phone:410-222-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0061987207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease