Provider Demographics
NPI:1922094580
Name:JOSOVITZ, KENNETH NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:NEIL
Last Name:JOSOVITZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14010 SMOKETOWN ROAD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-580-0181
Mailing Address - Fax:703-897-8763
Practice Address - Street 1:14010 SMOKETOWN RD
Practice Address - Street 2:SUITE 117
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4704
Practice Address - Country:US
Practice Address - Phone:703-580-0181
Practice Address - Fax:703-897-8763
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2024-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054566207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5858640Medicaid
VA5858640Medicaid
VAG33001Medicare UPIN