Individual
LAURENCE R KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15215 SHADY GROVE RD, SUITE 306, ROCKVILLE, MD 20850-3235
(301) 990-0040
(301) 990-0043
Mailing address
15215 SHADY GROVE RD, SUITE 306, ROCKVILLE, MD 20850-3235
(301) 990-0040
(301) 990-0043
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
D0047655
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009
BCBS OF DC INDIVIDUAL #
DC
01
—
4787
BCBS OF DC GROUP NUMBER
DC
01
—
53607302
BCBS OF MD INDIVIDUAL #
MD
01
—
H830
BCBS OF MD GROUP NUMBER
MD
Enumeration date
04/03/2006
Last updated
10/16/2007
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