Most Relevant Information
Provider Data
| NPI Number: | 1003817966 |
| Provider Name: | KENNETH E MCCOLLEY PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | 0110-840685 |
Most Important Dates
| Enumeration Date: | 08/02/2005 |
| Last Updated: | 09/22/2010 |
Provider Practice Location
3700 S MAIN ST
BLACKSBURG
VA
240607017
Practice Location Phone/Fax
| Phone: | 5409535122 |
| Fax: |
Provider Mailing Location
105 SHERWOOD DR
COLONIAL HEIGHTS
VA
238341226
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |