Provider Demographics
NPI:1245216670
Name:FALLS CHURCH MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:FALLS CHURCH MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IVER
Authorized Official - Middle Name:
Authorized Official - Last Name:KASENETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-533-2222
Mailing Address - Street 1:6060 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2943
Mailing Address - Country:US
Mailing Address - Phone:703-533-2222
Mailing Address - Fax:703-536-0414
Practice Address - Street 1:6060 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2943
Practice Address - Country:US
Practice Address - Phone:703-533-2222
Practice Address - Fax:703-536-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101017060207N00000X
VA0101046682207R00000X
VA0101050421207R00000X
VA0101234914207R00000X
VA0101234667207R00000X
VA0101031511207W00000X
VA0101057772208000000X
VA0101232408208000000X
VA01010340372085R0202X
VA0101032078208800000X
VA0103000649213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA409616F16Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
VA0678950001Medicare NSC