Individual
KELLY DAVID GAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
618 HOSPITAL ROAD, RIVERSIDE TAPPAHANNOCK HOSPITAL, TAPPAHANNOCK, VA 22560-5000
(804) 443-6044
(757) 867-7547
Mailing address
PO BOX 12087, PENNINSULA RADIOLOGICAL ASSOCIATES, NEWPORT NEWS, VA 23612-2087
(757) 867-6101
(757) 867-7547
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101242665
VA
2085R0202X
Diagnostic Radiology Physician
01053434A
IN
2085R0202X
Diagnostic Radiology Physician
4301110085
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356324370
—
VA
Enumeration date
11/23/2005
Last updated
11/01/2024
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