=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821732496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY KOLBE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2022
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 N WASHINGTON ST STE 490
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-765-6093
-----------------------------------------------------
Fax | 615-936-3601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 802 SUMMIT AVE
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22302-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 0101284670
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------