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NPI Code Detail

MEDICARE: JOHN KELLY M.D.

MEDICARE: JOHN KELLY M.D.
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 Physician0101266447VA

General Provider Information

NPI Number : 1972952125
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN KELLY M.D.
Provider Business Mailing Address
First Line : 1088 LONDON LINKS DR
Second Line :
City : FOREST
State : VA
Zip : 24551-4662
Country : US
Telephone Number : 434-534-6868
Fax Number :
Provider Business Practice Location Address
First Line : 1088 LONDON LINKS DR
Second Line :
City : FOREST
State : VA
Zip : 24551-4662
Country : US
Telephone Number : 574-647-7477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2016
Last Update Date : 07/18/2019

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