Provider Demographics
NPI:1831325539
Name:VON ELTEN, KELLEY ANN (MD)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANN
Last Name:VON ELTEN
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 1:7229 FOREST AVE STE 104B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3765
Mailing Address - Country:US
Mailing Address - Phone:804-285-5000
Mailing Address - Fax:833-979-0929
Practice Address - Street 1:7229 FOREST AVE STE 104B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3765
Practice Address - Country:US
Practice Address - Phone:804-285-5000
Practice Address - Fax:804-979-0929
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249077207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN