Provider Demographics
NPI:1922481993
Name:MARCHIANO, KELLEY NICOLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:NICOLE
Last Name:MARCHIANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:NICOLE
Other - Last Name:PRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9000 FRANKLIN SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:443-777-7000
Mailing Address - Fax:
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant