Provider Demographics
NPI:1710206057
Name:GAUTHIER, ALEXANDRE F (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:F
Last Name:GAUTHIER
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 1:6400 ARLINGTON BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2349
Mailing Address - Country:US
Mailing Address - Phone:703-288-9001
Mailing Address - Fax:703-288-5169
Practice Address - Street 1:6400 ARLINGTON BLVD STE 600
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2349
Practice Address - Country:US
Practice Address - Phone:703-288-9001
Practice Address - Fax:703-288-5169
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447489207W00000X
FLME127152207W00000X
VA0101255729207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710206057Medicaid
MD0799203 00Medicaid
DC066323900Medicaid
MD0799203 00Medicaid
DC358393ZA9WMedicare UPIN