Basic Information
| Provider Information | |||||||||
| NPI: | 1285212126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAUX-DUGAN | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 774 CHRISTIANA RD STE 101 | ||||||||
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| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197134248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023550005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4170 CITY AVE | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191311610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025883721 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2021 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | C50011607 | DE | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.