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Individual

DR. KEVIN CHARLES KELLEHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4901 BRAMBLETON AVE, ROANOKE, VA 24018-4149
(540) 777-4000
(540) 777-4007
Mailing address
2000 HEALTH PARK DR FL HP2, BRENTWOOD, TN 37027-4525
(615) 373-7600
(877) 767-2310

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101034582
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0019776794
STATE ID
VA
Enumeration date
11/15/2006
Last updated
10/30/2019
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