Provider Demographics
NPI:1205099322
Name:KELLY, URSULA MARTA (MD)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:MARTA
Last Name:KELLY
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 1:301 RIVERVIEW AVE STE 710
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9040
Mailing Address - Fax:757-252-9041
Practice Address - Street 1:301 RIVERVIEW AVE STE 710
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9040
Practice Address - Fax:757-252-9041
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01080020A207RI0200X
VA0101247897207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01386657Medicare PIN
VAPAROtherCIGNA
VA10064728OtherOPTIMA HEALTH
VA415006OtherANTHEM BC/BS
VAPAROtherMULTIPLAN
VA-028OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA HEALTH NETWORK
VA1205099322Medicaid
VAPAROtherAETNA
VAPAROtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherCORVEL/CORCARE
VAVAA102890Medicare PIN
VAPAROtherUNITED HEALTH CARE/MAMSI
NC5915587Medicaid
VAPAROtherUSA MANAGED CARE