Provider Demographics
NPI:1851435408
Name:BANAGAN, KELLEY E (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:E
Last Name:BANAGAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:920 ELKRIDGE LANDING RD
Mailing Address - Street 2:SUITE 11B
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2917
Mailing Address - Country:US
Mailing Address - Phone:410-328-6040
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:SUITE 11B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD72819207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine