Provider Demographics
NPI:1598724056
Name:ALEXANDRIA FAIRFAX NEUROLOGY, PC
Entity Type:Organization
Organization Name:ALEXANDRIA FAIRFAX NEUROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-845-1599
Mailing Address - Street 1:1500 N BEAUREGARD ST
Mailing Address - Street 2:#300
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1723
Mailing Address - Country:US
Mailing Address - Phone:703-845-1500
Mailing Address - Fax:703-845-1300
Practice Address - Street 1:1500 N BEAUREGARD ST
Practice Address - Street 2:#300
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1723
Practice Address - Country:US
Practice Address - Phone:703-845-1500
Practice Address - Fax:703-845-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT APPLICABLE174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACI8991OtherRAILROAD GROUP #
VA34244OtherKAISER GROUP #
VA34244OtherKAISER GROUP #