Provider Demographics
NPI:1295140879
Name:AZZAM, KEVIN ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:AZZAM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3300 GALLOWS RD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE, INOVA FAIRFAX HOSPITAL
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-776-2173
Mailing Address - Fax:703-776-3020
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:DEPARTMENT OF MEDICINE, INOVA FAIRFAX HOSPITAL
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-2173
Practice Address - Fax:703-776-3020
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2019-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102205381207R00000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program