Individual
DR. KENNETH R MIRKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3028 JAVIER RD STE 500, FAIRFAX, VA 22031
(703) 698-8960
(571) 494-5794
Mailing address
3700 JOSEPH SIEWICK DR STE 308, FAIRFAX, VA 22033-1739
(703) 698-8960
(703) 716-8703
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0101036056
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100010309
RAILROAD MEDICARE
VA
01
—
178732
ANTHEM BCBS
—
01
—
187598
ANTHEM BCBS
—
01
—
231620
ANTHEM BCBS
—
01
—
336682
ANTHEM BCBS
—
01
—
341902
ANTHEM BCBS
—
05
—
6096026
—
VA
01
—
740013
ANTHEM BCBS
—
01
—
79160004
CAREFIRST BCBS
—
Enumeration date
01/31/2006
Last updated
01/21/2025
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