Provider Demographics
NPI:1528008612
Name:KUSTRA, KERRI (MD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:KUSTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7611 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 108 W
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2611
Mailing Address - Country:US
Mailing Address - Phone:703-658-7060
Mailing Address - Fax:703-658-3150
Practice Address - Street 1:2942 HUNTER MILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1762
Practice Address - Country:US
Practice Address - Phone:703-658-7060
Practice Address - Fax:703-658-3150
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H16686Medicare UPIN