Healthcare Provider Details

I. General information

NPI: 1841123460
Provider Name (Legal Business Name): MARILYN KENESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 BOONE BLVD STE 720
TYSONS CORNER VA
22182-2683
US

IV. Provider business mailing address

474 BLOOMINGROVE DR
TROY NY
12180-8616
US

V. Phone/Fax

Practice location:
  • Phone: 703-454-5544
  • Fax:
Mailing address:
  • Phone: 518-944-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: