Active NPI
Edward Joseph Kelly IV, MD
- General Practice Physician
- Washington, DC
National Provider Identifier
1679134910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0101279260
- Practice address
- 900 23Rd St NW
Washington, DC 20037-2342 - Phone
- (202) 715-4000
- NPI assigned
- Jun 26, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0101279260 | VA | Primary |
Addresses
Primary practice location
900 23Rd St NW
Washington, DC 20037-2342
Mailing address
900 23Rd St NW
Washington, DC 20037-2342
Phone (443) 690-6281
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101279260 | VA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706313600000",
"number": "1679134910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 23RD ST NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200372342",
"telephone_number": "443-690-6281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 23RD ST NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200372342",
"telephone_number": "202-715-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "EDWARD",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"name_suffix": "IV",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-26",
"last_updated": "2024-01-27",
"certification_date": "2024-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0101279260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.