Provider Demographics
NPI:1407056419
Name:RUPERT, ALEXANDRA SASHA (DO,)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:SASHA
Last Name:RUPERT
Suffix:
Gender:F
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MARTHA CUSTIS DRIVE
Mailing Address - Street 2:SUITE C-7
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-998-6760
Mailing Address - Fax:703-998-2389
Practice Address - Street 1:1225 MARTHA CUSTIS DR
Practice Address - Street 2:SUITE C-7
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2000
Practice Address - Country:US
Practice Address - Phone:703-998-6760
Practice Address - Fax:703-998-2389
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037169204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE76218Medicare UPIN