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General NPI Number Information
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NPI Number | 1861408932
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Entity Type | Individual
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Provider Name | KELLY E KING MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 3600 JOSEPH SIEWICK DR
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City | FAIRFAX
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State | VA
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Zip | 22033
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Country | US
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Telephone | 703-391-3600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 494
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City | NASSAU
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State | DE
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Zip | 19969-0494
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Country | US
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Telephone | 302-569-0352
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Fax | 302-645-9714
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 0101054870
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101054870
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License Number State | VA
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