Provider Demographics
NPI:1508149881
Name:BRENAN ROTHSCHILD, KELLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:BRENAN ROTHSCHILD
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 1:708 REGESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212
Mailing Address - Country:US
Mailing Address - Phone:267-229-1361
Mailing Address - Fax:443-275-1250
Practice Address - Street 1:708 REGESTER AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212
Practice Address - Country:US
Practice Address - Phone:267-229-1361
Practice Address - Fax:443-275-1250
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1035041207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology