Individual
KIRSTEN K EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8081 INNOVATION PARK DR, FAIRFAX, VA 22031-4867
(571) 472-4724
(571) 472-0241
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101055411
VA
2086X0206X
Surgical Oncology Physician
0101055411
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7306521
—
VA
Enumeration date
09/22/2005
Last updated
11/27/2023
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