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Organization
NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC
Active
Organization
NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAGNUS K IKHINMWIN MD (MEDICAL DIRECTOR)
(703) 204-1614
Entity
Organization
Contact information
Practice address
3650 JOSEPH SIEWICK DR STE 310, FAIRFAX, VA 22033-1715
(703) 758-8800
(703) 758-9500
Mailing address
10882 MIMOSA PLACE, OAKTON, VA 22124
(703) 204-1614
(703) 204-1826
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
0101057344
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005856141
—
VA
01
—
00B485N64
DC MEDICARE
DC
01
—
00V069N17
VA MEDICARE
—
01
—
08492993A
GEORGIA MEDICAID
—
01
—
1102268673
MEDICARE RAILROAD
—
01
—
1121069
FIRST HEALTH
—
01
—
2614802
AETNA HMO
—
01
—
279891
AMERIGROUP
—
01
—
289502
ALLIANCE PPO
—
01
—
319481
ANTHEM
—
01
—
391480
ANTHEM
—
01
—
41838
GWU HP
—
01
—
490807
MEDICARE
—
01
—
5402030870
AARP UNITED HEALTHCARE
—
01
—
5972317
AETNA PPO
—
01
—
8989317
CIGNA
—
01
—
9458135
CALIFORNIA MEDICAID
—
01
—
F078 0001
BC CAREFIRST
—
01
—
XYPLA8274
CALIFORNIA MEDICAID
—
Enumeration date
01/09/2007
Last updated
12/21/2023
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