MEDICARE: DR. MATTHEW GUY KESTENBAUM 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	207R00000X	Internal Medicine Physician	0101232319	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101232319	OTHER	VA	VA LICENSE

General Provider Information

NPI Number	:	1619063955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW GUY KESTENBAUM M.D.

Provider Business Mailing Address
First Line	:	24419 MILLSTREAM DR
Second Line	:
City	:	ALDIE
State	:	VA
Zip	:	20105-5837
Country	:	US
Telephone Number	:	703-957-1768
Fax Number	:

Provider Business Practice Location Address
First Line	:	6565 ARLINGTON BLVD
Second Line	:	SUITE 500
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-3013
Country	:	US
Telephone Number	:	703-396-6197
Fax Number	:	703-779-1372

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	10/30/2015

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