Provider Demographics
NPI:1649243031
Name:MAPLES, KELLY M (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:MAPLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RIVERVIEW
Mailing Address - Street 2:STE 301
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510
Mailing Address - Country:US
Mailing Address - Phone:757-668-8255
Mailing Address - Fax:757-688-9444
Practice Address - Street 1:300 RIVERVIEW AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:757-668-8255
Practice Address - Fax:757-668-9444
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237473207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010134986Medicaid
VA7692114OtherCIGNA
VA178379OtherANTHEM
VA010134986Medicaid
VAI26986Medicare UPIN