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General NPI Number Information
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NPI Number | 1104844760
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Entity Type | Individual
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Provider Name | GARY M. KELLMAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 2722 MERRILEE DR #230
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City | FAIRFAX
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State | VA
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Zip | 22031-4400
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Country | US
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Telephone | 703-698-4483
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Fax | 703-573-0880
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Provider Business Mailing Address
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Address Line | PO BOX 3650
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City | MERRIFIELD
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State | VA
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Zip | 22116-3650
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Country | US
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Telephone | 703-698-4483
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Fax | 703-573-0880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 0101048839
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 0101048839
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | 0101048839
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 0101048839
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D0087855
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G183989
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 0101048839
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License Number State | VA
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Taxonomy #8
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 0101048839
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License Number State | VA
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Taxonomy #9
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101048839
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License Number State | VA
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