Healthcare Provider Details

I. General information

NPI: 1134252455
Provider Name (Legal Business Name): KELLEY PAGLIAI REDBORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY ANNE PAGLIAI MD

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10680 MAIN ST STE 200
FAIRFAX VA
22030-3810
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 703-352-2620
  • Fax: 703-352-2594
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101241641
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number0101241641
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: