Healthcare Provider Details

I. General information

NPI: 1386606549
Provider Name (Legal Business Name): MELISSA D KERN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46161 WESTLAKE DR STE 300
STERLING VA
20165-5871
US

IV. Provider business mailing address

46161 WESTLAKE DR STE 300
STERLING VA
20165-5871
US

V. Phone/Fax

Practice location:
  • Phone: 571-434-2927
  • Fax: 571-434-0838
Mailing address:
  • Phone: 703-434-2927
  • Fax: 703-908-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101053080
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number0101053080
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: