Provider Demographics
NPI:1164486106
Name:KISELICA, DARIA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DARIA
Middle Name:
Last Name:KISELICA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 INVESTIGATION PKWY
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-5173
Mailing Address - Country:US
Mailing Address - Phone:703-632-5084
Mailing Address - Fax:
Practice Address - Street 1:2500 INVESTIGATION PKWY
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5173
Practice Address - Country:US
Practice Address - Phone:703-632-5084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010420172083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010195837Medicaid
VA1000870001OtherDME PROVIDER
189326OtherANTHEM/BCBS
321001OtherSOUTHERN HEALTH
VA5597393OtherCIGNA
VA93459OtherOPTIMA
WV71513000OtherWV MEDICAID
VAB07263Medicare UPIN
189326OtherANTHEM/BCBS