Basic Information
| Provider Information | |||||||||
| NPI: | 1598767808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KITCES | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 9816 MAYLAND DR | ||||||||
| Address2: | 100 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232331457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042828510 | ||||||||
| FaxNumber: | 8042855750 | ||||||||
| Practice Location | |||||||||
| Address1: | 9816 MAYLAND DR | ||||||||
| Address2: | 100 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232331457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042828510 | ||||||||
| FaxNumber: | 8042855750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 02/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101028959 | VA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 54-1256850 | 01 | VA | AETNA | OTHER | 54-1256850 | 01 | VA | GREAT WEST | OTHER | 1598767808 | 01 | VA | UNITED HEALTHCARE | OTHER | 5905991 | 05 | VA | MEDICAID | 134566 | 01 | VA | SOUTHERN HEALTH | OTHER | 212036 | 01 | VA | CIGNA | OTHER | 49D0227531 | 01 | VA | CLIA | OTHER | 258638 | 01 | VA | ANTHEM | OTHER |