Healthcare Provider Details

I. General information

NPI: 1851365878
Provider Name (Legal Business Name): KATHLEEN P KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY ROAD
ALEXANDRIA VA
22304
US

IV. Provider business mailing address

1300 PICCARD DRIVE SUITE 202
ROCKVILLE MD
20850-4303
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3066
  • Fax: 703-504-3866
Mailing address:
  • Phone: 301-921-7900
  • Fax: 301-921-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number0101042375
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: