Individual
KELLY E KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3600 JOSEPH SIEWICK DR, FAIRFAX, VA 22033
(703) 391-3600
Mailing address
PO BOX 494, NASSAU, DE 19969-0494
(302) 569-0352
(302) 645-9714
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101054870
VA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
0101054870
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010113261
—
VA
Enumeration date
07/31/2006
Last updated
07/28/2020
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