Healthcare Provider Details

I. General information

NPI: 1326242082
Provider Name (Legal Business Name): C.W. KESSLER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 ARLINGTON BLVD SUITE T-5
FAIRFAX VA
22031-2902
US

IV. Provider business mailing address

8301 ARLINGTON BLVD SUITE T-5
FAIRFAX VA
22031-2902
US

V. Phone/Fax

Practice location:
  • Phone: 703-208-2273
  • Fax: 703-208-0710
Mailing address:
  • Phone: 703-208-2273
  • Fax: 703-208-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101023952
License Number StateVA

VIII. Authorized Official

Name: DR. CHESTER WILLIAM KESSLER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 702-208-2273