Provider Demographics
NPI:1073280327
Name:ROSAVAN ALEXANDRIA LLC
Entity Type:Organization
Organization Name:ROSAVAN ALEXANDRIA LLC
Other - Org Name:FEDERAL INJURY CENTERS OF ALEXANDRIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-863-2822
Mailing Address - Street 1:4703 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1816
Mailing Address - Country:US
Mailing Address - Phone:301-455-1348
Mailing Address - Fax:
Practice Address - Street 1:5249 DUKE ST STE 301
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2907
Practice Address - Country:US
Practice Address - Phone:240-863-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty