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NPI Code Detail

MEDICARE: KELLI LINICK MD

MEDICARE: KELLI LINICK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0101-052921VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851364756
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI LINICK MD
Provider Business Mailing Address
First Line : 548 BLUE RIDGE AVE
Second Line :
City : BEDFORD
State : VA
Zip : 24523-2604
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 548 BLUE RIDGE AVE
Second Line :
City : BEDFORD
State : VA
Zip : 24523-2604
Country : US
Telephone Number : 540-586-4723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 01/21/2016

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Directions to “ KELLI LINICK MD” Practice Location

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