Individual provider Active NPI

Kenneth Sherrard Kelleher Jr., M.D., FACS

  • Surgery Physician
  • Bethesda, MD
National Provider Identifier
1992766588
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0101032853 Issued in VA
Practice address
National Naval Medical Center
8901 Wisconsin Ave
Bethesda, MD 20889-0001
Phone
(301) 295-4472
Fax
(301) 295-0959
NPI assigned
Mar 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 0101032853 VA Primary

Addresses

Primary practice location

National Naval Medical Center
8901 Wisconsin Ave
Bethesda, MD 20889-0001

Mailing address

1311 Roosevelt St
Alexandria, VA 22302-3129
Phone (703) 671-1386

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150601001792 MD Order and Referring Only - General SurgeryPractitioner - General Surgery 2264753342

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101032853VAMDSurgery Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1992766588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 ROOSEVELT ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223023129",
            "telephone_number": "703-671-1386",
            "fax_number": "301-295-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NATIONAL NAVAL MEDICAL CENTER",
            "address_2": "8901 WISCONSIN AVE",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208890001",
            "telephone_number": "301-295-4472",
            "fax_number": "301-295-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEHER",
        "first_name": "KENNETH",
        "middle_name": "SHERRARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D., FACS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101032853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

Verify at the official NPI Registry.