KELLY LORAINE DAUER PHAM MD
NPI 1417274689
Physical Medicine & Rehabilitation - Pediatric Rehabilitation Medicine in Vienna, VA

Active since April 28, 2010PECOS EnrolledAccepts Medicare Assignment
8230 BOONE BLVD STE 170, VIENNA, VA 22182(571) 310-2502(571) 413-0290 Get Directions Write a Review

NPPES record last updated: April 13, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 13, 2022, Jun 28, 2016 (2 updates tracked since 2016).

About Kelly Loraine Dauer Pham Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY LORAINE DAUER PHAM MD (NPI 1417274689) is an individual pediatric rehabilitation medicine provider in Vienna, Virginia, licensed in Virginia (0101273373) and active in the NPI registry since April 2010. She is enrolled in Medicare PECOS, maintains a secondary practice location in Seattle, and is a graduate of Georgetown University School Of Medicine (2010).

NPPES Registry Identity

NPI1417274689
Entity TypeIndividualFemale
Primary Taxonomy2081P0010X
Provider Legal NameKELLY LORAINE DAUER PHAMCredential: MD
Location Address8230 BOONE BLVD STE 170Vienna, VA 22182-2621
Mailing Address8230 Boone Blvd Ste 170Vienna, VA 22182-2621 · (571) 310-2502 · Fax (571) 413-0290
Fax(571) 413-0290
Sole ProprietorYes
Medical School CMSGeorgetown University School Of MedicineGraduated 2010
Enumeration DateApril 28, 2010
Last NPPES UpdateApril 13, 20222 updates tracked since enumeration
NPPES CertifiedApril 13, 2022
NPI 1417274689 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPhysical Medicine & Rehabilitation · Pediatric Rehabilitation MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2081P0010X
Licenses Licensed in VA · 0101273373 Licensed in WA · FE60464961
Definition

A physiatrist who utilizes an interdisciplinary approach and addresses the prevention, diagnosis, treatment and management of congenital and childhood-onset physical impairments including related or secondary medical, physical, functional, psychosocial and vocational limitations or conditions, with an understanding of the life course of disability. This physician is trained in the identification of functional capabilities and selection of the best of rehabilitation intervention strategies, with an understanding of the continuum of care.

Also ListedPhysical Medicine & RehabilitationTaxonomy 208100000X · License 0101273373 (VA), 185401 (DC)
8230 BOONE BLVD STE 170, Vienna, VA 22182

Other Names 1

Former Name (1)Kelly Loraine Dauer Md

Secondary Practice Location 1

Location 14800 Sand Point Way NE, Department of Pediatric Rehabilitation MedicineSeattle, WA 98105-3901 · Phone (206) 987-1766 · Fax (206) 987-2651

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Kelly Loraine Dauer Pham Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1759530132
PECOS Enrollment IDI20230203001342
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Acupuncturist
8230 BOONE BLVD STE 170
VIENNA, VA 22182

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Pham's NPI number?

The NPI number for Kelly Pham is 1417274689. It was assigned to this individual provider in the NPPES registry on April 28, 2010. The provider is also known as Kelly Loraine Dauer MD.

Where is Kelly Pham located?

Kelly Pham practices at 8230 Boone Blvd Ste 170, Vienna, VA 22182. The listed phone number is (571) 310-2502.

What is Kelly Pham's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation, specializing in Pediatric Rehabilitation Medicine, with taxonomy code 2081P0010X.

Is Kelly Pham enrolled in Medicare?

Yes. Kelly Pham is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Kelly Pham was last updated on April 13, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.