Look up the most recent NPI and PECOS records

Kelly J Tanenholz

Internal Medicine

Allopathic & Osteopathic Physicians

1201 Seven Locks Rd, Ste 111, Rockville, MD 20854-2931

PECOS Enrollment

This provider is enrolled in PECOS as KELLY TANENHOLZ.

Based on the most recent information from CMS, provider Kelly J Tanenholz is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1780688424
Provider Type
Individual
Full Name
Tanenholz, Kelly J
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
6/10/2005
Last Updated
2/4/2015

Contact Information

Practice Location

1201 Seven Locks Rd, Ste 111, Rockville, MD 20854-2931

(301) 762-5020

(301) 294-7569

Mailing Location

PO Box 79632, Baltimore, MD 21279-0632

(301) 762-5020

(301) 309-3783

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License D0058604 Maryland

Provider Identifiers

ID	Description	Issuer
ID 982841900	Description Medicaid	Issuer Unlisted Maryland

Kelly J Tanenholz

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

M Medical Group, Inc.

Silverman, William Henry

Kaleko, Michael

Kassis, Leonard Khalil

Do, Robert T

Kellogg, Patricia Deal

Zheng, Yanfang

White, John Douglas

Privia Medical Group, Llc

Kinnaird, Alexander N.