Provider Demographics
NPI:1346267986
Name:KELLEHER, A. BRIAN (MD, PC)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:BRIAN
Last Name:KELLEHER
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 SUNRISE BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2516
Mailing Address - Country:US
Mailing Address - Phone:804-739-4879
Mailing Address - Fax:
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-330-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027778207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA114223OtherBLUE SHIELD
VA005810043Medicaid
VA005809983Medicaid
VA114708OtherBLUE SHIELD
VA114708OtherBLUE SHIELD
VA114223OtherBLUE SHIELD
B05952Medicare UPIN