Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD1657 | DC |
NPI | 1073580668 |
---|---|
Provider Name | Dr. John M. Keshishian |
First Address | Mc Lean, VA 22102-1537 |
Second Address | Washington, DC 20010-2976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B93260 | (02) | DC |