Provider Demographics
NPI:1134613003
Name:KELLY, VICTORIA ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6523
Mailing Address - Country:US
Mailing Address - Phone:757-473-0044
Mailing Address - Fax:
Practice Address - Street 1:134 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6523
Practice Address - Country:US
Practice Address - Phone:757-473-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018706390200000X
VA0102207144207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program