Provider Demographics
NPI:1467650077
Name:KILCOYNE, KELLY G (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:G
Last Name:KILCOYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:127 LUBRANO DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7369
Mailing Address - Country:US
Mailing Address - Phone:410-544-4263
Mailing Address - Fax:855-394-3899
Practice Address - Street 1:127 LUBRANO DR STE 202
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7369
Practice Address - Country:US
Practice Address - Phone:410-544-4263
Practice Address - Fax:855-394-3899
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD75966207X00000X, 207XS0114X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No171000000XOther Service ProvidersMilitary Health Care Provider