Organization
GENERATIONS FAMILY MEDICINE PC
Active
Other names
Generations Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN JOHN KELLEHER MD (MEDICAL DIRECTOR)
(703) 464-0686
Entity
Organization
Contact information
Practice address
12040 S LAKES DR, STE 190, RESTON, VA 20191-1246
(703) 464-0686
(703) 464-0698
Mailing address
12040 S LAKES DR, SUITE 207, RESTON, VA 20191-1246
(703) 464-0686
(703) 464-0698
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101054571
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G00463
MEDICARE GROUP NO.
—
Enumeration date
05/25/2007
Last updated
01/04/2013
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