Individual
KELLY MARIE AXSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032
(646) 317-2268
Mailing address
630 W 168TH ST, BOX 4, NEW YORK, NY 10032-3725
(646) 317-2268
Taxonomy
Speciality
Code
Description
License number
State
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
258685
NY
Other
Enumeration date
06/04/2008
Last updated
06/19/2018
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