Individual
KELLY HAUSENBAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
310 W NINTH ST, FREDERICK, MD 21701-4546
(301) 695-6800
(301) 695-6891
Mailing address
310 W NINTH ST, FREDERICK, MD 21701-4546
(301) 695-6800
(301) 695-6891
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0004612
MD
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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