Individual
ROBERT E. KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-7703
(757) 668-8860
Mailing address
PO BOX 741593, CHILDRENS SURGICAL SPECIALTY GROUP INC, ATLANTA, GA 30374-1593
(757) 668-7703
(757) 668-8860
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
0101050898
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006732861
—
VA
01
—
15404
OPTIMA/SENTARA HEALTH
VA
01
—
265055
ANTHEM BCBS
VA
01
—
311610834
NC HEALTH CHOICE
VA
01
—
3116108340002E
CIGNA
VA
01
—
321883
MAMSI/OPTIMUM CHOICE
VA
01
—
4480859
AETNA
VA
01
—
8906998
NORTH CAROLINA MEDICAID
VA
05
—
8906998
—
NC
Enumeration date
08/01/2006
Last updated
12/26/2012
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