Provider Demographics
NPI:1710689658
Name:KELLEN, MARY ALLISON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALLISON
Last Name:KELLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ALLISON
Other - Last Name:CONTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8414 NAAB RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1972
Mailing Address - Country:US
Mailing Address - Phone:317-338-7510
Mailing Address - Fax:317-338-7540
Practice Address - Street 1:8414 NAAB RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1972
Practice Address - Country:US
Practice Address - Phone:317-338-7510
Practice Address - Fax:317-338-7540
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program