Individual
BENNY O IKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5812 HANNORA LN, FAIRFAX STATION, VA 22039-1428
(703) 764-8012
(703) 463-1845
Mailing address
5812 HANNORA LN, FAIRFAX STATION, VA 22039-1428
(703) 764-8012
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101046304
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010144108
—
VA
Enumeration date
07/28/2005
Last updated
12/04/2009
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