Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101241641 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 0101241641 | VA |
NPI | 1134252455 |
---|---|
Provider Name | Dr. Kelley Pagliai Redbord |
First Address | Baltimore, MD 21279-0262 |
Second Address | Vienna, VA 22180-4434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 28/03/2008 |