Healthcare Provider Details

I. General information

NPI: 1831400548
Provider Name (Legal Business Name): KESTUTIS AUKSTUOLIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 OLD GALLOWS RD STE 205
VIENNA VA
22182-3931
US

IV. Provider business mailing address

1945 OLD GALLOWS RD STE 205
VIENNA VA
22182-3931
US

V. Phone/Fax

Practice location:
  • Phone: 703-403-5413
  • Fax:
Mailing address:
  • Phone: 703-403-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0102202879
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: