Provider Demographics
NPI:1477723260
Name:KISSI, LUDMILA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUDMILA
Middle Name:MARIE
Last Name:KISSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUDMILA
Other - Middle Name:MARIE
Other - Last Name:JANECKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:14800 LEE HWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-1842
Practice Address - Country:US
Practice Address - Phone:703-743-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236996207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH74036Medicare UPIN