Provider Demographics
NPI:1447494281
Name:KELLEY, CARLY ELIZABETH (MD)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:ELIZABETH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ELIZABETH
Other - Last Name:PODNOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4603 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8631
Mailing Address - Country:US
Mailing Address - Phone:919-381-6207
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY MEDICAL CTR
Practice Address - Street 2:8254 DUKE NORTH-DUMC 3182, ERWIN ROAD
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:973-972-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine