Individual
DR. KEVIN J KELLEHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12040 S LAKES DR, STE 207, RESTON, VA 20191-1246
(703) 464-0686
(703) 464-0698
Mailing address
12040 S LAKES DR, STE 207, RESTON, VA 20191-1246
(703) 464-0686
(703) 464-0698
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101054571
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G00463
MEDICARE GROUP
VA
Enumeration date
07/26/2005
Last updated
09/10/2014
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