Healthcare Provider Details

I. General information

NPI: 1760778120
Provider Name (Legal Business Name): KAPIL VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 ROSEHAVEN ST STE 210
FAIRFAX VA
22030-2877
US

IV. Provider business mailing address

10521 ROSEHAVEN ST STE 210
FAIRFAX VA
22030-2877
US

V. Phone/Fax

Practice location:
  • Phone: 703-652-4251
  • Fax: 703-652-8470
Mailing address:
  • Phone: 703-652-4251
  • Fax: 703-652-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101264040
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: