Most Relevant Information
Provider Data
| NPI Number: | 1003479254 |
| Provider Name: | KILEY KATHERINE FAGAN MD |
| Entity Type: | Individual |
| Taxonomy Code: | 207N00000X |
| Specialty: | Dermatology |
| License Number: | 0101281436 |
Most Important Dates
| Enumeration Date: | 04/15/2019 |
| Last Updated: | 10/09/2024 |
Provider Practice Location
1 RIVERSIDE CIR STE 300
ROANOKE
VA
240164962
Practice Location Phone/Fax
| Phone: | 5402245170 |
| Fax: |
Provider Mailing Location
213 S JEFFERSON ST STE 1006
ROANOKE
VA
240111713
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |