1770576878 NPI number — DR. BRENDA ROBIN KIESSLING MD

Table of content: DR. HASHEM M FARR MD (NPI 1336164375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770576878 NPI number — DR. BRENDA ROBIN KIESSLING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIESSLING
Provider First Name:
BRENDA
Provider Middle Name:
ROBIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770576878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10610 HUNTERS VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22181-3018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-938-9389
Provider Business Mailing Address Fax Number:
703-460-9359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 TELESTAR CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-396-6197
Provider Business Practice Location Address Fax Number:
703-779-1372
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  101037093 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5699088 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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