Provider Demographics
NPI:1942355607
Name:ALEXANDRIA SURGERY LTD
Entity Type:Organization
Organization Name:ALEXANDRIA SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-823-5900
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1313
Mailing Address - Country:US
Mailing Address - Phone:703-823-5900
Mailing Address - Fax:703-751-1849
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-823-5900
Practice Address - Fax:703-751-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029682208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00764Medicare PIN