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1689653784

NPI Code Detail

MEDICARE: DR. KEVIN FRICKA MD

MEDICARE: DR. KEVIN FRICKA 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
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	0101239380	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	259963	OTHER		KAISER
2	1429314	OTHER		AETNA HMO
3	1429314	OTHER		AETNA PPO
4	7235819	OTHER		AETNA ID
5	763958	OTHER		NCPPO
6	2155571	OTHER		MAMSI ID
7	148820100	OTHER		DEPT OF LABOR ID
8	239324	OTHER		ANTHEM ID
9	2683333	OTHER		UNITED ID
10	25090077	OTHER		BLUE CROSS BLUE SHIELD ID

General Provider Information

NPI Number	:	1689653784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN FRICKA MD

Provider Business Mailing Address
First Line	:	2800 S SHIRLINGTON RD STE 1000
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3614
Country	:	US
Telephone Number	:	703-892-6500
Fax Number	:	703-521-3415

Provider Business Practice Location Address
First Line	:	2501 PARKERS LN STE 200
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3209
Country	:	US
Telephone Number	:	703-892-6500
Fax Number	:	703-799-5989

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/24/2023

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Directions to “ DR. KEVIN FRICKA MD” Practice Location

Language	Start Address	Practice Location

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