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General NPI Number Information
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NPI Number | 1982672937
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Entity Type | Individual
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Provider Name | IVAN AKSENTIJEVICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVE STE 1018
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1306
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Country | US
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Telephone | 571-483-1800
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Fax | 703-823-5723
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Provider Business Mailing Address
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Address Line | 3040 WILLIAMS DR SUITE 100
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City | FAIRFAX
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State | VA
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Zip | 22031-4618
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Country | US
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Telephone | 703-208-3963
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Fax | 703-205-6284
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 0101234651
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 0101234651
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 0101234651
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License Number State | VA
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