Provider Demographics
NPI:1841240462
Name:KELLEHER, MARGARET ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:KELLEHER
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 1:4200 N ARMENIA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6451
Mailing Address - Country:US
Mailing Address - Phone:813-877-4811
Mailing Address - Fax:813-872-8978
Practice Address - Street 1:6110 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1142
Practice Address - Country:US
Practice Address - Phone:727-821-3600
Practice Address - Fax:727-821-3611
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 63128207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
306242OtherAVMED
1368171OtherCOVENTRY
FL18974OtherFL BLUE
7416827OtherAETNA
1368171OtherCOVENTRY