Individual
KELLY L. GEOGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
1447 YORK ROAD, SUITE 504, LUTHERVILLE, MD 21093-6097
(410) 753-4422
(410) 753-4660
Mailing address
1447 YORK ROAD, SUITE 504, LUTHERVILLE, MD 21093-6097
(410) 753-4422
(410) 753-4660
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
01285
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6614180001
MEDICARE DMEPOS
MD
01
—
CDJ4KL 758639-06
CAREFIRST
MD
01
—
CDJ4KL 758639-07
CAREFIRST
MD
01
—
Y410-0001
CAREFIRST
DC
Enumeration date
08/10/2005
Last updated
05/16/2013
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