Provider Demographics
NPI:1457311748
Name:NORTHERN NECK NEPHROLOGY PC
Entity Type:Organization
Organization Name:NORTHERN NECK NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-435-2651
Mailing Address - Street 1:86 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-3845
Mailing Address - Country:US
Mailing Address - Phone:804-435-2651
Mailing Address - Fax:804-435-2302
Practice Address - Street 1:86 HARRIS RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3845
Practice Address - Country:US
Practice Address - Phone:804-435-2651
Practice Address - Fax:804-435-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366402455OtherDR. KINSEL NPI
VA1366402455OtherDR. KINSEL NPI