Provider Demographics
NPI:1720615495
Name:MAAG, KELSEY LYN (DO)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYN
Last Name:MAAG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 TRUEMAN COURT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026
Mailing Address - Country:US
Mailing Address - Phone:614-777-4801
Mailing Address - Fax:614-777-8644
Practice Address - Street 1:3841 TRUEMAN COURT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026
Practice Address - Country:US
Practice Address - Phone:614-777-4801
Practice Address - Fax:614-777-8644
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.017059207V00000X
OH34-017059207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology