Provider Demographics
NPI:1023075538
Name:KELEMEN, MICHAEL HOWARD (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOWARD
Last Name:KELEMEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-2704
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:5450 KNOLL NORTH DR
Practice Address - Street 2:SUITE 200B
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2300
Practice Address - Country:US
Practice Address - Phone:410-964-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18047207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410141300Medicaid
MDB69555Medicare UPIN
MDKR34N523Medicare PIN