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General NPI Number Information
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NPI Number | 1992766588
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Entity Type | Individual
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Provider Name | KENNETH SHERRARD KELLEHER JR. M.D., FACS
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | NATIONAL NAVAL MEDICAL CENTER 8901 WISCONSIN AVE
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City | BETHESDA
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State | MD
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Zip | 20889-0001
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Country | US
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Telephone | 301-295-4472
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Fax | 301-295-0959
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Provider Business Mailing Address
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Address Line | 1311 ROOSEVELT ST
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City | ALEXANDRIA
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State | VA
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Zip | 22302-3129
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Country | US
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Telephone | 703-671-1386
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Fax | 301-295-0959
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101032853
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License Number State | VA
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