Provider Demographics
NPI:1164827762
Name:PROSPER, GUY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:DAVID
Last Name:PROSPER
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 1:9203C FOREST HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-3202
Mailing Address - Country:US
Mailing Address - Phone:301-351-4191
Mailing Address - Fax:
Practice Address - Street 1:6565 ARLINGTON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3000
Practice Address - Country:US
Practice Address - Phone:703-534-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0092938208000000X
VA0101260176208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics