Individual
DR. KELLY O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
166 DEFENSE HWY, SUITE 101, ANNAPOLIS, MD 21401-8919
(410) 224-3390
(410) 224-3370
Mailing address
166 DEFENSE HWY STE 101, ANNAPOLIS, MD 21401-8921
(410) 224-3390
(410) 224-3370
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
D0042645
MD
207L00000X
Anesthesiology Physician
MD32654
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0113
CAREFIRST BCBS
DC
05
—
027449600
—
DC
01
—
212103
KAISER
DC
05
—
234501301
—
MD
01
—
2561122
AETNA HMO
DC
01
—
3058246001
CIGNA HMO
DC
01
—
441777
ANTHEM BCBS
VA
01
—
566739
NCPPO
DC
01
—
5711193
VIRGINIA MEDICAID
VA
01
—
7016224
AETNA NON HMO
DC
Enumeration date
07/20/2006
Last updated
06/20/2023
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