Provider Demographics
NPI:1730116575
Name:RUSTOGI, ALOK (MD)
Entity Type:Individual
Prefix:
First Name:ALOK
Middle Name:
Last Name:RUSTOGI
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 1:46090 LAKE CENTER PLZ
Mailing Address - Street 2:201
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5876
Mailing Address - Country:US
Mailing Address - Phone:703-489-0508
Mailing Address - Fax:703-468-1061
Practice Address - Street 1:46090 LAKE CENTER PLZ
Practice Address - Street 2:201
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5876
Practice Address - Country:US
Practice Address - Phone:703-489-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236706207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA206438OtherANTHEM BC
P00382573OtherMEDICARE RAILROAD
VA10270880Medicaid
VA00X191I01Medicare PIN
MDI31382Medicare UPIN
VA10270880Medicaid