Provider Demographics
NPI:1720027915
Name:STUART, KELLY (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:412 LIBBIE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2659
Mailing Address - Country:US
Mailing Address - Phone:804-282-8082
Mailing Address - Fax:804-282-9082
Practice Address - Street 1:412 LIBBIE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2659
Practice Address - Country:US
Practice Address - Phone:804-282-8082
Practice Address - Fax:804-282-9082
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010516882080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine