Provider Demographics
NPI:1619063955
Name:KESTENBAUM, MATTHEW GUY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GUY
Last Name:KESTENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24419 MILLSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5837
Mailing Address - Country:US
Mailing Address - Phone:703-957-1768
Mailing Address - Fax:
Practice Address - Street 1:6565 ARLINGTON BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3013
Practice Address - Country:US
Practice Address - Phone:703-396-6197
Practice Address - Fax:703-779-1372
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101232319OtherVA LICENSE
VA490073Medicare ID - Type UnspecifiedMEDICARE
VAG69729Medicare UPIN