Provider Demographics
NPI:1033261003
Name:KAUFMAN-GREEN, KELLY JO (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:KAUFMAN-GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5249 DUKE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2907
Mailing Address - Country:US
Mailing Address - Phone:703-751-2616
Mailing Address - Fax:703-370-8275
Practice Address - Street 1:5249 DUKE ST STE 5
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-751-2616
Practice Address - Fax:703-370-8275
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240772207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology