Individual
DR. GORDON NEIL KELLETT II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13821 VILLAGE MILL DR, MIDLOTHIAN, VA 23114-4365
(804) 794-2821
(804) 794-4072
Mailing address
PO BOX 549, MIDLOTHIAN, VA 23113-0549
(804) 794-2821
(804) 794-4072
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101025852
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006703941
—
VA
01
—
11360
CIGNA
VA
01
—
1200296
UNITED HEALTH CARE
VA
01
—
128503
SOUTHERN HEALTH
VA
01
—
21688
CARENT
VA
01
—
217017
ANTHEM
VA
Enumeration date
07/31/2006
Last updated
01/12/2009
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