Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 0101267034 | VA |
N | 2084N0402X | Child Neurologist | MD047420 | DC |
NPI | 1407275662 |
---|---|
Provider Name | Meaghan Kelly |
First Address | Fairfax, VA 22031-2207 |
Second Address | Fairfax, VA 22031-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 06/08/2019 |