Provider Demographics
NPI:1083328850
Name:ALDER, ANTHONY CHARLES (PA-C, DMS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CHARLES
Last Name:ALDER
Suffix:
Gender:M
Credentials:PA-C, DMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 TYSONS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4227
Mailing Address - Country:US
Mailing Address - Phone:703-738-4381
Mailing Address - Fax:703-790-0971
Practice Address - Street 1:1750 TYSONS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4227
Practice Address - Country:US
Practice Address - Phone:703-738-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical