1497739254 NPI number — KENNETH L HARKAVY MD

Table of content: KENNETH L HARKAVY MD (NPI 1497739254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497739254 NPI number — KENNETH L HARKAVY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARKAVY
Provider First Name:
KENNETH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1497739254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 PICCARD DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-921-7900
Provider Business Mailing Address Fax Number:
301-921-7915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 TOWN CENTER PKWY
Provider Second Line Business Practice Location Address:
RESTON HOSPITAL CENTER
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-689-9037
Provider Business Practice Location Address Fax Number:
703-689-9109
Provider Enumeration Date:
12/05/2005

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: 208000000X , with the licence number:  0101234409 , 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)





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