Provider Demographics
NPI:1457300543
Name:KELLING, CARMEN GABRIELA (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:GABRIELA
Last Name:KELLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:GABRIELA
Other - Last Name:MILETI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1909 214TH ST SE STE 300
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4418
Mailing Address - Country:US
Mailing Address - Phone:425-412-7200
Mailing Address - Fax:
Practice Address - Street 1:1909 214TH ST SE STE 300
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4418
Practice Address - Country:US
Practice Address - Phone:425-412-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60922024207R00000X
NC2007-00669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP020152OtherGATEWAY HEALTH PLAN
NC2021855AMedicare PIN
NCP020152OtherGATEWAY HEALTH PLAN
H96190Medicare UPIN
NCNCM516AMedicare PIN
NCNCM516BMedicare PIN