Provider Demographics
NPI:1346251279
Name:NAKKA, KAVITHA KISHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:KISHORE
Last Name:NAKKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 WINTER WREN CT
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-1830
Mailing Address - Country:US
Mailing Address - Phone:703-560-0404
Mailing Address - Fax:703-560-0202
Practice Address - Street 1:8301 ARLINGTON BLVD
Practice Address - Street 2:SUITE # T-5
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-560-0404
Practice Address - Fax:703-560-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0101234646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010051291Medicaid
G01506K01OtherMEDICARE RR
VA010051291Medicaid
DCG01506K01Medicare PIN