Provider Demographics
NPI:1083871800
Name:BAGASRA, ALEXANDER UMAR (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:UMAR
Last Name:BAGASRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 WAPLES MILL RD 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7406
Mailing Address - Country:US
Mailing Address - Phone:703-246-9560
Mailing Address - Fax:
Practice Address - Street 1:11211 WAPLES MILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7406
Practice Address - Country:US
Practice Address - Phone:703-246-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254953207R00000X
VA0101-254053207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine