Provider Demographics
NPI:1417957531
Name:CAMARDA, KELLY MITCHELL (MED)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MITCHELL
Last Name:CAMARDA
Suffix:
Gender:
Credentials:MED
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:147 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3807
Mailing Address - Country:US
Mailing Address - Phone:434-841-2170
Mailing Address - Fax:
Practice Address - Street 1:147 COFFEE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-3807
Practice Address - Country:US
Practice Address - Phone:434-841-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001139231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA640004118OtherMEDICARE RAILROAD PTAN - DANNY W. GNEWIKOW, PH.D., LLC
VA1417957531Medicaid
VA640004119OtherMEDICARE RAILROAD PTAN - AUDIOLOGY HEARING AID ASSOCIATES, INC.
VA640000112OtherMEDICARE PALMETTO GBA PTAN (AUDIOLOGY HEARING AID ASSOCIATES, INC.)
VAVAA103114OtherMEDICARE PALMETTO GBA PTAN (DANNY W. GNEWIKOW, PH.D., LLC)
VA541361858OtherPIEDMONTCOMMUNITYHLTHPLAN
VA541361858OtherPRIMARY PHYSICIAN CARE-LY
VAP33302Medicare UPIN
VA540964595OtherPRIMARY PHYSICIAN CARE-DA
VA218161OtherANTHEM OF VA-LYN
VA248043OtherANTHEM OF VA - DANVILLE
VA640000113Medicare ID - Type UnspecifiedMEDICARE-TRAILBLAZER-DAN