Provider Demographics
NPI:1336142306
Name:KITCES, EDWARD N (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:N
Last Name:KITCES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9816 MAYLAND DR
Mailing Address - Street 2:100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1457
Mailing Address - Country:US
Mailing Address - Phone:804-282-8510
Mailing Address - Fax:804-285-5750
Practice Address - Street 1:9816 MAYLAND DR
Practice Address - Street 2:100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1457
Practice Address - Country:US
Practice Address - Phone:804-282-8510
Practice Address - Fax:804-285-5750
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336142306OtherUNITED HEALTHCARE
VA49D0227531OtherCLIA
VA147955OtherSOUTHERN HEALTH
VA453808OtherANTHEM
VA54-1256850OtherAETNA
VA5901243Medicaid
VA027878OtherCIGNA
VA54-1256850OtherGREAT WEST
VA070000338Medicare ID - Type Unspecified
VA1336142306OtherUNITED HEALTHCARE