Provider Demographics
NPI: | 1376508267 |
---|---|
Name: | ALEWINE, THOMAS CHRISTOPHER (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | THOMAS |
Middle Name: | CHRISTOPHER |
Last Name: | ALEWINE |
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: | 2722 MERRILEE DR |
Mailing Address - Street 2: | SUITE 230 |
Mailing Address - City: | FAIRFAX |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22031-4420 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-698-4444 |
Mailing Address - Fax: | 703-573-0880 |
Practice Address - Street 1: | 2722 MERRILEE DR |
Practice Address - Street 2: | SUITE 230 |
Practice Address - City: | FAIRFAX |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22031-4420 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-698-4444 |
Practice Address - Fax: | 703-573-0880 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-04-20 |
Last Update Date: | 2022-04-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101057842 | 2085B0100X, 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 0101057842 | Other | LICENSE |
VA | 0101057842 | Other | LICENSE |