Provider Demographics
NPI:1629062872
Name:KRIST, ALEXANDER H (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:H
Last Name:KRIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3650 JOSEPH SIEWICK DR
Mailing Address - Street 2:STE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1710
Mailing Address - Country:US
Mailing Address - Phone:703-391-2020
Mailing Address - Fax:703-391-1211
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:STE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-391-2020
Practice Address - Fax:703-391-1211
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05622492Medicaid
VA080179721OtherRR MEDICARE
VA05622492Medicaid
VA00A414F32Medicare ID - Type Unspecified