Provider Demographics
NPI:1356360416
Name:KIVANC, MERT TUGRUL (DO)
Entity type:Individual
Prefix:
First Name:MERT
Middle Name:TUGRUL
Last Name:KIVANC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 ARLINGTON BLVD
Mailing Address - Street 2:SUITE # 940
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2325
Mailing Address - Country:US
Mailing Address - Phone:703-241-1010
Mailing Address - Fax:703-241-7723
Practice Address - Street 1:6400 ARLINGTON BLVD
Practice Address - Street 2:SUITE # 940
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2325
Practice Address - Country:US
Practice Address - Phone:703-241-1010
Practice Address - Fax:703-241-7723
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050060207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH25486Medicare UPIN
VA490842Medicare ID - Type Unspecified