Provider Demographics
NPI:1720366347
Name:FAWCETT, KELSEY JYL (MD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:JYL
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD NW DEPT OF
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-5437
Mailing Address - Fax:202-444-2961
Practice Address - Street 1:3800 RESERVOIR RD NW DEPT OF
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-5437
Practice Address - Fax:202-444-2961
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY279584207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program