Provider Demographics
NPI:1417215799
Name:KHERADI, ALEXANDER ROSTAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:ROSTAM
Last Name:KHERADI
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 1:409 S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3605
Mailing Address - Country:US
Mailing Address - Phone:610-324-0577
Mailing Address - Fax:
Practice Address - Street 1:1050 WEST PERIMETER ROAD
Practice Address - Street 2:
Practice Address - City:JOINT BASE ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:240-857-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0077343207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine