Provider Demographics
NPI:1497072177
Name:WORMER, KELLY COMEFORD (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:COMEFORD
Last Name:WORMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:P
Other - Last Name:COMERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 S TRYON ST
Practice Address - Street 2:STE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4958
Practice Address - Country:US
Practice Address - Phone:704-316-3000
Practice Address - Fax:704-316-3001
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164849207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology