Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101050897 | VA |
Y | 2080P0201X | Pediatric Allergist | 0101050897 | VA |
NPI | 1184663460 |
---|---|
Provider Name | Cynthia S Kelly |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 09/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000982001 | (05) | DE |
006722083 | (05) | VA |
1010085990001 | (05) | PA |
1802398000 | (05) | WV |
522500100 | (05) | MD |
890688I | (05) | NC |
F84341 | (02) |