Provider Demographics
NPI:1376738930
Name:WASHBURN, KELLY M (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:WASHBURN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:20280 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-1331
Mailing Address - Country:US
Mailing Address - Phone:757-414-0400
Mailing Address - Fax:757-414-0569
Practice Address - Street 1:17068 LANKFORD HIGHWAY
Practice Address - Street 2:
Practice Address - City:EASTVILLE
Practice Address - State:VA
Practice Address - Zip Code:23347
Practice Address - Country:US
Practice Address - Phone:757-331-1086
Practice Address - Fax:757-442-9505
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2020-06-04
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Provider Licenses
StateLicense IDTaxonomies
MA233266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021586P95 - C03895Medicare PIN