Provider Demographics
NPI:1801231170
Name:SEEDLOCK, KYLE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ELIZABETH
Last Name:SEEDLOCK
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 1:10571 TELEGRAPH RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4652
Mailing Address - Country:US
Mailing Address - Phone:804-266-9616
Mailing Address - Fax:804-261-4935
Practice Address - Street 1:10571 TELEGRAPH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4652
Practice Address - Country:US
Practice Address - Phone:804-266-9616
Practice Address - Fax:804-261-4935
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259713208000000X
VA0116025686390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics