Provider Demographics
NPI:1689844391
Name:INTERNAL MEDICINE PHYSICIANS OF ALEXANDRIA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE PHYSICIANS OF ALEXANDRIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:LUKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-922-6161
Mailing Address - Street 1:6412 BEULAH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2671
Mailing Address - Country:US
Mailing Address - Phone:703-922-6161
Mailing Address - Fax:703-922-1899
Practice Address - Street 1:6412 BEULAH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2671
Practice Address - Country:US
Practice Address - Phone:703-922-6161
Practice Address - Fax:703-922-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1401OtherCAREFIRST BLUE CROSS BLUE
VA409571Medicare PIN