Basic Information
Provider Information
NPI: 1649324476
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLDEN
FirstName: KELLY
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 EAST JEFFERSON STREET
Address2: KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
City: ROCKVILLE
State: MD
PostalCode: 20852
CountryCode: US
TelephoneNumber: 3018166660
FaxNumber: 3018166308
Practice Location
Address1: 1011 NORTH CAPITOL STREET
Address2:  
City: WASHINGTON
State: DC
PostalCode: 20002
CountryCode: US
TelephoneNumber: 2028985100
FaxNumber: 2028985470
Other Information
ProviderEnumerationDate: 01/22/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XMD30294DCY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207V00000XD0052376MDN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home