Provider Demographics
NPI:1134110059
Name:KASENETZ, IVER (MD)
Entity Type:Individual
Prefix:DR
First Name:IVER
Middle Name:
Last Name:KASENETZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 ARLINGTON BOULEVARD
Mailing Address - Street 2:FALLS CHURCH MEDICAL CENTER
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2993
Mailing Address - Country:US
Mailing Address - Phone:703-533-2222
Mailing Address - Fax:703-533-3457
Practice Address - Street 1:6060 ARLINGTON BOULEVARD
Practice Address - Street 2:FALLS CHURCH MEDICAL CENTER
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2993
Practice Address - Country:US
Practice Address - Phone:703-533-2222
Practice Address - Fax:703-533-3457
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032078208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007590300Medicaid
VA007590300Medicaid
VAB94723Medicare UPIN