Basic Information
| Provider Information | |||||||||
| NPI: | 1689653784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRICKA | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2445 ARMY NAVY DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222062905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038926500 | ||||||||
| FaxNumber: | 7037995989 | ||||||||
| Practice Location | |||||||||
| Address1: | 2445 ARMY NAVY DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222062905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038926500 | ||||||||
| FaxNumber: | 7037995989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | 0101239380 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 763958 | 01 | NCPPO | OTHER | 25090077 | 01 | BLUE CROSS BLUE SHIELD ID | OTHER | 2683333 | 01 | UNITED ID | OTHER | 1429314 | 01 | AETNA HMO | OTHER | 1429314 | 01 | AETNA PPO | OTHER | 239324 | 01 | ANTHEM ID | OTHER | 7235819 | 01 | AETNA ID | OTHER | 148820100 | 01 | DEPT OF LABOR ID | OTHER | 259963 | 01 | KAISER | OTHER | 2155571 | 01 | MAMSI ID | OTHER |