Provider Demographics
NPI:1710130828
Name:KOWALCHIK, KRISTIN V (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:V
Last Name:KOWALCHIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6906
Mailing Address - Country:US
Mailing Address - Phone:540-662-1108
Mailing Address - Fax:450-540-2244
Practice Address - Street 1:400 CAMPUS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-662-1108
Practice Address - Fax:450-540-2244
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012584282085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710130828Medicaid
FL14R2ROtherBCBSFL
FL367729OtherAVMED
FL4988541OtherAETNA
FL1115930OtherCARE PLUS
FL8263117OtherCIGNA
FLP01451910OtherRR MEDICARE
FL1115930OtherCARE PLUS
FLHL216PMedicare PIN