Provider Demographics
NPI:1689653784
Name:FRICKA, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:FRICKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 S SHIRLINGTON RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3614
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-521-3415
Practice Address - Street 1:2501 PARKERS LN STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-799-5989
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239380207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
259963OtherKAISER
1429314OtherAETNA HMO
1429314OtherAETNA PPO
7235819OtherAETNA ID
763958OtherNCPPO
2155571OtherMAMSI ID
148820100OtherDEPT OF LABOR ID
239324OtherANTHEM ID
2683333OtherUNITED ID
25090077OtherBLUE CROSS BLUE SHIELD ID
25090077OtherBLUE CROSS BLUE SHIELD ID
763958OtherNCPPO
ILI42308Medicare UPIN