Provider Demographics
NPI:1649447228
Name:KELLY, KATHRYN DELORES GARRETT (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DELORES GARRETT
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10801 LOCKWOOD DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1556
Mailing Address - Country:US
Mailing Address - Phone:301-298-1040
Mailing Address - Fax:844-288-6896
Practice Address - Street 1:10801 LOCKWOOD DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:301-298-1040
Practice Address - Fax:844-288-6896
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2016-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA065580207R00000X
DCMD038654207R00000X
MDD0076087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD188991ZEUQMedicare PIN