Healthcare Provider Details

I. General information

NPI: 1134110059
Provider Name (Legal Business Name): IVER KASENETZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 ARLINGTON BOULEVARD FALLS CHURCH MEDICAL CENTER
FALLS CHURCH VA
22044-2993
US

IV. Provider business mailing address

6060 ARLINGTON BOULEVARD FALLS CHURCH MEDICAL CENTER
FALLS CHURCH VA
22044-2993
US

V. Phone/Fax

Practice location:
  • Phone: 703-533-2222
  • Fax: 703-533-3457
Mailing address:
  • Phone: 703-533-2222
  • Fax: 703-533-3457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101032078
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: