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NPI Code Detail

MEDICARE: MR. KEVIN ANDREW EDINBOROUGH MD

MEDICARE: MR. KEVIN ANDREW EDINBOROUGH MD
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
1207Q00000XFamily Medicine Physician0116032978VA
2207QS0010XSports Medicine (Family Medicine) Physician0101270783VA

General Provider Information

NPI Number : 1144880303
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN ANDREW EDINBOROUGH MD
Provider Business Mailing Address
First Line : 3650 JOSEPH SIEWICK DR STE 400
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-1715
Country : US
Telephone Number : 703-391-2020
Fax Number : 703-391-1211
Provider Business Practice Location Address
First Line : 3650 JOSEPH SIEWICK DR STE 400
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-1715
Country : US
Telephone Number : 703-391-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2019
Last Update Date : 04/17/2026

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