Provider Demographics
NPI:1922048230
Name:ALEXANDRIA PERINATAL DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:ALEXANDRIA PERINATAL DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR INOVA ALEXANDRIA HOSP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOZLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:703-504-3167
Mailing Address - Street 1:2876 GUARDIAN LANE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7327
Mailing Address - Country:US
Mailing Address - Phone:757-463-5240
Mailing Address - Fax:757-463-6572
Practice Address - Street 1:4320 SEMINARY ROAD
Practice Address - Street 2:INOVA ALEXANDRIA HOSPITAL DIAGNOSTIC CENTER
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1535
Practice Address - Country:US
Practice Address - Phone:703-504-7868
Practice Address - Fax:703-504-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical CytogeneticsGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2504OtherCAREFIRST
VA=========001OtherHEALTHNET TRICARE CHAMPUS
VA=========OtherMDIPA MAMSI OPTIMUM CHOIC