Provider Demographics
NPI:1760824403
Name:KELEHER, EAMON (MD (STAFF PHYSICIAN))
Entity Type:Individual
Prefix:DR
First Name:EAMON
Middle Name:
Last Name:KELEHER
Suffix:
Gender:M
Credentials:MD (STAFF PHYSICIAN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 BALBOA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1592
Mailing Address - Country:US
Mailing Address - Phone:619-645-0155
Mailing Address - Fax:619-645-0193
Practice Address - Street 1:8808 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1592
Practice Address - Country:US
Practice Address - Phone:619-645-0155
Practice Address - Fax:619-645-0193
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074623A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine