Healthcare Provider Details

I. General information

NPI: 1710045976
Provider Name (Legal Business Name): LISA STEHLI KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NORTH VIRGINIA AVENUE
FALLS CHURCH VA
22046
US

IV. Provider business mailing address

107 NORTH VIRGINIA AVENUE
FALLS CHURCH VA
22046
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4446
  • Fax: 703-532-8426
Mailing address:
  • Phone: 703-532-4446
  • Fax: 703-532-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101237717
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD035348
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: