Provider Demographics
NPI:1952447716
Name:KIVLAHAN, COLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:COLEEN
Middle Name:
Last Name:KIVLAHAN
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 1:1319 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-1520
Mailing Address - Country:US
Mailing Address - Phone:571-594-2223
Mailing Address - Fax:
Practice Address - Street 1:1319 23RD ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-1520
Practice Address - Country:US
Practice Address - Phone:571-594-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD040366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine