Healthcare Provider Details

I. General information

NPI: 1194936799
Provider Name (Legal Business Name): WILLIAM KELLY DEHART DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 INDEPENDENCE PKWY STE 600
CHESAPEAKE VA
23320-5220
US

IV. Provider business mailing address

6160 KEMPSVILLE CIR SUITE 200 A
NORFOLK VA
23502-3933
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-6315
  • Fax: 757-622-7022
Mailing address:
  • Phone: 757-622-6315
  • Fax: 757-562-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0102202224
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: