Individual
STEPHEN J KELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3369 COLONIAL AVE SW, ROANOKE, VA 24018-3739
(540) 772-0555
Mailing address
2918 EDGEFIELD CIR, VINTON, VA 24179-1510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101-236571
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010070902
—
VA
Enumeration date
12/09/2005
Last updated
08/12/2011
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