Provider Demographics
NPI:1447227988
Name:KELLY, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 COLONIAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4025
Mailing Address - Country:US
Mailing Address - Phone:540-774-6000
Mailing Address - Fax:540-774-5276
Practice Address - Street 1:4231 COLONIAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4002
Practice Address - Country:US
Practice Address - Phone:540-774-6000
Practice Address - Fax:540-774-5276
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101028920207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447227988Medicaid
VA006208843Medicaid
VAB08553Medicare UPIN
VA1447227988Medicaid
VA160001357Medicare ID - Type Unspecified
VAP01323854Medicare PIN