Provider Demographics
NPI:1154359040
Name:KELLY, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8220 MEADOWBRIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2336
Mailing Address - Country:US
Mailing Address - Phone:804-764-1253
Mailing Address - Fax:804-764-1259
Practice Address - Street 1:8220 MEADOWBRIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2336
Practice Address - Country:US
Practice Address - Phone:804-764-1253
Practice Address - Fax:804-764-1259
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101037821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1383250OtherCIGNA
VA45906OtherSENTARA
VA296096OtherMAMSI
VA4458500OtherAETNA HMO
VA432880OtherANTHEM BCBS OF VA
VA79153OtherSOUTHERN HEALTH SERVICES
VA110170382OtherRAILROAD MEDICARE
VA005847851Medicaid
VA4458500OtherAETNA LIFE
VAB05296Medicare UPIN
110007093Medicare ID - Type Unspecified