Healthcare Provider Details

I. General information

NPI: 1275865123
Provider Name (Legal Business Name): AARON M. KISTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN RD STE 60
ANNANDALE VA
22003-7337
US

IV. Provider business mailing address

3289 WOODBURN RD STE 60
ANNANDALE VA
22003-7337
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-9573
  • Fax: 703-698-1592
Mailing address:
  • Phone: 703-698-9573
  • Fax: 703-698-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number0101035830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: