Provider Demographics
NPI:1134252455
Name:REDBORD, KELLEY PAGLIAI (MD)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:PAGLIAI
Last Name:REDBORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:ANNE
Other - Last Name:PAGLIAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 79262
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0262
Mailing Address - Country:US
Mailing Address - Phone:703-938-5700
Mailing Address - Fax:703-938-4467
Practice Address - Street 1:243 CHURCH ST NW
Practice Address - Street 2:SUITE 200-C
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4434
Practice Address - Country:US
Practice Address - Phone:703-938-5700
Practice Address - Fax:703-938-4467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241641207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00477Medicare PIN