Provider Demographics
NPI:1841750601
Name:MCLEOD, KELSEY (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MCLEOD
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 1:2200 ST LUKES BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5665
Mailing Address - Country:US
Mailing Address - Phone:484-503-0060
Mailing Address - Fax:833-466-8211
Practice Address - Street 1:2200 ST LUKES BLVD STE 201
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5665
Practice Address - Country:US
Practice Address - Phone:484-503-0060
Practice Address - Fax:833-466-8211
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD000000208000000X
390200000X
PAMD477976208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGC83599JMedicaid