Provider Demographics
NPI:1508155300
Name:DANOWSKI, KELLI MAYO (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:MAYO
Last Name:DANOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KELLI
Other - Middle Name:L
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:525 ROUTE 73 S STE 305A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9644
Mailing Address - Country:US
Mailing Address - Phone:856-420-6070
Mailing Address - Fax:870-890-4610
Practice Address - Street 1:525 ROUTE 73 S STE 305A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9644
Practice Address - Country:US
Practice Address - Phone:856-420-6070
Practice Address - Fax:870-890-4610
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018143207N00000X, 207N00000X
NJ25MB09622700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508155300OtherNPI
NJ25MB09622700OtherSTATE LICENSE
PAOS018143OtherSTATE LICENSE
PAP01701913OtherRAILROAD MEDICARE