Individual
DR. KATHLEEN A KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12255 FAIR LAKES PKWY, FAIRFAX, VA 22033-3952
(703) 934-5700
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101054869
VA
207R00000X
Internal Medicine Physician
D51285
MD
207R00000X
Internal Medicine Physician
MD039430
DC
208000000X
Pediatrics Physician
Primary
0101054869
VA
208000000X
Pediatrics Physician
D51285
MD
208000000X
Pediatrics Physician
MD039430
DC
Other
Enumeration date
01/09/2007
Last updated
12/20/2022
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