Provider Demographics
NPI:1245297506
Name:ALEXANDRIA GERIATRIC CARE
Entity type:Organization
Organization Name:ALEXANDRIA GERIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-759-2724
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-0641
Mailing Address - Country:US
Mailing Address - Phone:703-759-2724
Mailing Address - Fax:703-759-2724
Practice Address - Street 1:10006 THOMPSON RIDGE CT
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066
Practice Address - Country:US
Practice Address - Phone:703-759-6294
Practice Address - Fax:703-759-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5872936Medicaid
G3900001OtherBCBS
G00895Medicare PIN