Provider Demographics
NPI:1487656815
Name:DONNELLY, KATHLEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3300 GALLOWS RD
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3307
Mailing Address - Country:US
Mailing Address - Phone:703-776-6652
Mailing Address - Fax:703-776-6078
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-6652
Practice Address - Fax:703-776-6078
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-07-20
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Provider Licenses
StateLicense IDTaxonomies
NY2181962080P0203X
VA01012404172080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02110034Medicaid
NYG16368Medicare UPIN
NY02110034Medicaid
DC020434I99Medicare PIN