Provider Demographics
NPI:1316023187
Name:KISTHARDT, ANNE C (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:C
Last Name:KISTHARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:STE 902
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1313
Mailing Address - Country:US
Mailing Address - Phone:703-370-4300
Mailing Address - Fax:703-370-1683
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:STE 902
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-370-4300
Practice Address - Fax:703-370-1683
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD061119L207V00000X
VA0101058294207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG82597Medicare UPIN