Provider Demographics
NPI:1902193980
Name:KEMP, KELVIN D (MD)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:D
Last Name:KEMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 TANKARD RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-6548
Mailing Address - Country:US
Mailing Address - Phone:586-838-0832
Mailing Address - Fax:
Practice Address - Street 1:3700 FETTLER PARK DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-2050
Practice Address - Country:US
Practice Address - Phone:703-441-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVF600AMedicare PIN
VA377111YWAUMedicare PIN