| John Edward Kelly Md Pa | |
|
2401 Research Blvd Ste 340 Rockville MD 20850-6254 | |
| (301) 212-9200 | |
| Not Available |
| Full Name | John Edward Kelly Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 2401 Research Blvd Ste 340, Rockville, Maryland |
| Authorized Official Name and Position | John Edward Kelly (PRESIDENT) |
| Authorized Official Contact | 3012129200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John Edward Kelly Md Pa 2401 Research Blvd Ste 340 Rockville MD 20850-6254 Ph: (301) 212-9200 | John Edward Kelly Md Pa 2401 Research Blvd Ste 340 Rockville MD 20850-6254 Ph: (301) 212-9200 |
| NPI Number | 1407158850 |
|---|---|
| Provider Enumeration Date | 11/17/2010 |
| Last Update Date | 12/15/2010 |
| Medicare PECOS PAC ID | 4688862576 |
|---|---|
| Medicare Enrollment ID | O20101220000178 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407158850 | NPI | - | NPPES |
| 113251200 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D0006349 (Maryland) | Primary |
| Provider Name | John Edward Kelly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558446195 PECOS PAC ID: 8022206911 Enrollment ID: I20101220000206 |
| Provider Name | Teresa Loan Hoang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295920650 PECOS PAC ID: 3274628672 Enrollment ID: I20110210000701 |
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