Provider Demographics
NPI:1760461164
Name:DUMM, KELLI J (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:J
Last Name:DUMM
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 1:300 KENTON DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1263
Mailing Address - Country:US
Mailing Address - Phone:304-346-5533
Mailing Address - Fax:304-346-5611
Practice Address - Street 1:300 KENTON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1263
Practice Address - Country:US
Practice Address - Phone:304-346-5533
Practice Address - Fax:304-346-5611
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1447349238OtherNPI NUMBER FOR GROUP PRACTICE
WVDC7713OtherUMWA GROUP NUMBER
WV001706175OtherBLUE CROSS NUMBER FOR GROUP
WVP00189318OtherUMWA PIN NUMBER FOR GROUP
WVP00215125OtherRAILROAD NUMBER FOR GROUP PRACTICE
WV3810001081Medicaid
WV001706175OtherBLUE CROSS NUMBER FOR GROUP
WV3810001081Medicaid