Provider Demographics
NPI:1982220190
Name:ST. THOMAS, ALICIA DERUSSO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:DERUSSO
Last Name:ST. THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 COLESBURY PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3240
Mailing Address - Country:US
Mailing Address - Phone:860-227-5495
Mailing Address - Fax:
Practice Address - Street 1:OBGYN ADMIN SUITE 2ND FLOOR SOUTH TOWER
Practice Address - Street 2:3300 GALLOWS RD
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:860-227-5495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program