Provider Demographics
NPI:1508685413
Name:KIM A KELLY, M.D., P.C.
Entity type:Organization
Organization Name:KIM A KELLY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-751-0090
Mailing Address - Street 1:5875 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4570
Mailing Address - Country:US
Mailing Address - Phone:301-702-2003
Mailing Address - Fax:301-702-2324
Practice Address - Street 1:5873 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4570
Practice Address - Country:US
Practice Address - Phone:301-702-2003
Practice Address - Fax:301-702-2324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIM A KELLY, M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care