Provider Demographics
NPI:1073919197
Name:BACHE, ALEXANDRA JEAN (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JEAN
Last Name:BACHE
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2901 TELESTAR CT STE 300
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1263
Mailing Address - Country:US
Mailing Address - Phone:703-591-1688
Mailing Address - Fax:703-591-1445
Practice Address - Street 1:44035 RIVERSIDE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8260
Practice Address - Country:US
Practice Address - Phone:703-858-5421
Practice Address - Fax:703-858-9573
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2021-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0005621363AM0700X
VA0110006143363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical