Provider Demographics
NPI:1144711946
Name:KELLEY, KATHRYN CLARE (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CLARE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARTIN CT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4095
Mailing Address - Country:US
Mailing Address - Phone:410-820-9400
Mailing Address - Fax:
Practice Address - Street 1:10 MARTIN CT
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4095
Practice Address - Country:US
Practice Address - Phone:410-820-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA185318208600000X
MDD0101274208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery