Provider Demographics
NPI:1396717708
Name:KELLING, DOUGLAS GEORGE JR (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GEORGE
Last Name:KELLING
Suffix:JR
Gender:M
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:STE 550
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-403-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19495207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC48196OtherBCBS
NC8948195Medicaid
NC4258213OtherAETNA ID FOR CONC INT
NC60835OtherMEDCOST
NC18916OtherWELLPATH
NC444256OtherMAMSI
NCP00195879OtherRAILROAD MEDICARE
NC4966OtherPARTNERS MEDICARE CHOICE
NC0440829OtherUNITED HEALTHCARE
NC232009OtherMEDICARE
NC207790EMedicare PIN
NC444256OtherMAMSI