Provider Demographics
NPI:1144254814
Name:KELLY, KAMILAH MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:KAMILAH
Middle Name:MICHELLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KAMILAH
Other - Middle Name:MICHELLE
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7377 WASHINGTON BLVD
Mailing Address - Street 2:CONCENTRA MEDICAL CENTER
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6360
Mailing Address - Country:US
Mailing Address - Phone:410-379-3051
Mailing Address - Fax:410-379-3074
Practice Address - Street 1:7377 WASHINGTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6360
Practice Address - Country:US
Practice Address - Phone:410-379-3051
Practice Address - Fax:410-379-3074
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062823207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I38991Medicare UPIN