Individual
ROBERT E. KELLY JR.
Active
Individual
ROBERT E. KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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