Healthcare Provider Details

I. General information

NPI: 1245216670
Provider Name (Legal Business Name): FALLS CHURCH MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 ARLINGTON BLVD
FALLS CHURCH VA
22044-2943
US

IV. Provider business mailing address

6060 ARLINGTON BLVD
FALLS CHURCH VA
22044-2943
US

V. Phone/Fax

Practice location:
  • Phone: 703-533-2222
  • Fax: 703-536-0414
Mailing address:
  • Phone: 703-533-2222
  • Fax: 703-536-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101032078
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101017060
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101031511
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101050421
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101234914
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101234667
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000649
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101057772
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101232408
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101034037
License Number StateVA
# 11
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101046682
License Number StateVA

VIII. Authorized Official

Name: DR. IVER KASENETZ
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 703-533-2222