Individual
MR. KEVIN F KELLEY SR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 STRAUSS AVE, CBIRF, 2ND MEF, INDIAN HEAD, MD 20640-1542
(301) 744-1004
(301) 744-1028
Mailing address
111 STRAUSS AVE, INDIAN HEAD, MD 20640-1524
(301) 744-1004
(301) 744-1028
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110840675
VA
Other
Enumeration date
03/24/2006
Last updated
07/08/2007
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