Organization
KELTON MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD A. KELTON M.D. (PRESIDENT)
(410) 787-4908
Entity
Organization
Contact information
Practice address
301 HOSPITAL DR, GLEN BURNIE, MD 21061-5803
(410) 787-4908
Mailing address
PO BOX 25757, BALTIMORE, MD 21224-0457
(410) 787-4908
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
D45018
MD
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
D0045018
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431303800
—
MD
01
—
DG4495
RAILROAD MEDICARE GROUP #
MD
01
—
F466
BLUECHOICE MARYLAND #
MD
01
—
LZ42KE
CAREFIRST, MARLYAND GROUP
MD
Enumeration date
09/26/2006
Last updated
05/12/2008
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