Provider Demographics
NPI:1205911096
Name:KIELY, JAMES MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATTHEW
Last Name:KIELY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:440 MONTICELLO AVE
Mailing Address - Street 2:STE 1802 PMB 18917
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2583
Mailing Address - Country:US
Mailing Address - Phone:757-916-8998
Mailing Address - Fax:
Practice Address - Street 1:440 MONTICELLO AVE
Practice Address - Street 2:STE 1802 PMB 18917
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2583
Practice Address - Country:US
Practice Address - Phone:757-916-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA048904174400000X, 2084N0400X
CAC1806412084N0400X
IDM-167892084N0400X
SC330642084N0400X
IN01078984A2084N0400X
NMMD2019-10862084N0400X
TXQ58412084N0400X
TN475602084N0400X
VA01010543872084N0400X
AZ466482084N0400X
WV315742084N0400X
KY444352084N0400X
NC2010-021172084N0400X
FLME1174952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13BDDFQMedicare PIN
GAH19589Medicare UPIN