Individual
MICHAEL E KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1510 N 28TH ST, SUITE 205, RICHMOND, VA 23223-5311
(804) 545-2304
(804) 545-2306
Mailing address
1510 N 28TH ST, SUITE 205, RICHMOND, VA 23223-5311
(804) 545-2304
(804) 545-2306
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101246237
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649302
—
NJ
01
—
C06695
GROUP PTAN
VA
Enumeration date
02/01/2006
Last updated
10/20/2020
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