Provider Demographics
NPI:1982672937
Name:AKSENTIJEVICH, IVAN (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:AKSENTIJEVICH
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 1:3040 WILLIAMS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:703-208-3963
Mailing Address - Fax:703-205-6284
Practice Address - Street 1:4660 KENMORE AVE STE 1018
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:571-483-1800
Practice Address - Fax:703-823-5723
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234651207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982672937Medicaid
VA7501495OtherAETNA PPO
VA316256-2107058OtherMAMSI/ OP CHOICE/ALLIANCE
VA541795091OtherCHOICE CARE
VA541795091OtherTRICARE
VA386769OtherANTHEM/TRIGON
VA560987OtherNCPPO
VA541795091OtherPHCS POS/PPO
VA08700018OtherBCBS NCA CARE FIRST
VA2311042OtherUNITED HEALTHCARE
VA541795091OtherONE HEALTH PLAN
VA3212244OtherAETNA HMO
VA541795091-2067228OtherFIRST HEALTH
VA6252107OtherCIGNA HMO/POS/PPO
VA560987OtherNCPPO
VA1982672937Medicaid
VA316256-2107058OtherMAMSI/ OP CHOICE/ALLIANCE