Provider Demographics
NPI:1891369484
Name:ELLIOTT, KATLYN CONNORS
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:CONNORS
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MARYLAND DEPARTMENT OF FAMILY AND COMMUIT
Mailing Address - Street 2:29 S PACA ST, LOWER LEVEL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:667-214-1880
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MARYLAND DEPARTMENT OF FAMILY AND COMMUIT
Practice Address - Street 2:29 S PACA ST, LOWER LEVEL, ATTN: PAM HOUGH
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:667-214-1880
Practice Address - Fax:412-673-2150
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program