Provider Demographics
NPI:1245791458
Name:CARLOCK, KURTIS DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:DAVID
Last Name:CARLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1715 NORTH GEORGE MASON DRIVE
Mailing Address - Street 2:MEDICAL OFFICES D, SUITE 504
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205
Mailing Address - Country:US
Mailing Address - Phone:703-525-2200
Mailing Address - Fax:
Practice Address - Street 1:1715 NORTH GEORGE MASON DR
Practice Address - Street 2:MEDICAL OFFICES D, SUITE 504
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-525-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101284933207XS0114X
IL036169088207XS0114X, 207X00000X
IN01093197A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery