Provider Demographics
NPI:1922131887
Name:ALEXANDRIA HEALTH CARE CENTER, PLLC
Entity Type:Organization
Organization Name:ALEXANDRIA HEALTH CARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMBRISH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-658-2650
Mailing Address - Street 1:6303 LITTLE RIVER TPKE STE 160
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5045
Mailing Address - Country:US
Mailing Address - Phone:703-658-2650
Mailing Address - Fax:703-658-2656
Practice Address - Street 1:6303 LITTLE RIVER TPKE STE 160
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5045
Practice Address - Country:US
Practice Address - Phone:703-658-2650
Practice Address - Fax:703-658-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty