Kelleher, Kevin J

Kelleher, Kevin J is an individual health care provider with primary practice located at 12040 S Lakes Dr Ste 207, Reston VA 20191-1246. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Kelleher, Kevin J can be contacted via phone (703) 464-0686.

Contact Information

Primary practice address
12040 S Lakes Dr Ste 207 Reston VA 20191-1246
Phone: (703) 464-0686
Fax: (703) 464-0698
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0101054571 Virginia

Profile Details

NPI number 1689674202
LBN Legal business name Kelleher, Kevin J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated Sep 10th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689674202 NPPES
Virginia Other G00463 MEDICARE GROUP

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