MEDICARE: FALLS CHURCH MEDICAL CENTER, INC.

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
2	207N00000X	Dermatology Physician	0101017060	VA
3	207W00000X	Ophthalmology Physician	0101031511	VA
4	207R00000X	Internal Medicine Physician	0101050421	VA
5	207R00000X	Internal Medicine Physician	0101234914	VA
6	207R00000X	Internal Medicine Physician	0101234667	VA
7	213E00000X	Podiatrist	0103000649	VA
8	208000000X	Pediatrics Physician	0101057772	VA
9	208000000X	Pediatrics Physician	0101232408	VA
10	2085R0202X	Diagnostic Radiology Physician	0101034037	VA
11	207R00000X	Internal Medicine Physician	0101046682	VA

General Provider Information

NPI Number	:	1245216670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALLS CHURCH MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	6060 ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2943
Country	:	US
Telephone Number	:	703-533-2222
Fax Number	:	703-536-0414

Provider Business Practice Location Address
First Line	:	6060 ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2943
Country	:	US
Telephone Number	:	703-533-2222
Fax Number	:	703-536-0414

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. IVER KASENETZ
Credential	:	M.D.
Telephone Number	:	703-533-2222

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	03/03/2008

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