Healthcare Provider Details

I. General information

NPI: 1598932592
Provider Name (Legal Business Name): ANTONINA Y KOLESNIKOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 VARNUM ST NE STE 202
WASHINGTON DC
20017-2153
US

IV. Provider business mailing address

1140 VARNUM ST NE STE 202
WASHINGTON DC
20017-2153
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-6430
  • Fax: 202-269-6598
Mailing address:
  • Phone: 202-269-6430
  • Fax: 202-269-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD036833
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMD036833
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMD036833
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberD0069258
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberMD036833
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberD0069258
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberD0069258
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberMD036833
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: