Active NPI
Mark Paul Kelly, PHD
- Clinical Psychologist
- Washington, DC
National Provider Identifier
1407958325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 02200
- Practice address
- 6900 Georgia Ave NW
Walter Reed Army Medical Center
Washington, DC 20307-0003 - Phone
- (202) 782-0065
- Fax
- (202) 782-7165
- NPI assigned
- Sep 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 02200 | MD | |
| Clinical Psychologist | 103TC0700X | 02200 | MD | Primary |
Addresses
Primary practice location
6900 Georgia Ave NW
Walter Reed Army Medical Center
Washington, DC 20307-0003
Mailing address
11 Stony Meadow CT
Lutherville, MD 21093-4532
Phone (410) 409-8890
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02200 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1407958325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 STONY MEADOW CT",
"city": "LUTHERVILLE",
"state": "MD",
"postal_code": "210934532",
"telephone_number": "410-409-8890",
"fax_number": "202-752-7165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 GEORGIA AVE NW",
"address_2": "WALTER REED ARMY MEDICAL CENTER",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "203070003",
"telephone_number": "202-782-0065",
"fax_number": "202-782-7165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MARK",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-01",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MD",
"license": "02200",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "02200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.