MEDICARE: DR. IVER KASENETZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	0101032078	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134110059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVER KASENETZ M.D.

Provider Business Mailing Address
First Line	:	6060 ARLINGTON BOULEVARD
Second Line	:	FALLS CHURCH MEDICAL CENTER
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2993
Country	:	US
Telephone Number	:	703-533-2222
Fax Number	:	703-533-3457

Provider Business Practice Location Address
First Line	:	6060 ARLINGTON BOULEVARD
Second Line	:	FALLS CHURCH MEDICAL CENTER
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2993
Country	:	US
Telephone Number	:	703-533-2222
Fax Number	:	703-533-3457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	02/09/2012

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