Provider Demographics
NPI:1295899953
Name:ROLFE, ALAN ELLIS (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ELLIS
Last Name:ROLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 SUNSAIL CIR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4756
Mailing Address - Country:US
Mailing Address - Phone:757-469-9714
Mailing Address - Fax:
Practice Address - Street 1:8505 ARLINGTON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4630
Practice Address - Country:US
Practice Address - Phone:703-846-0076
Practice Address - Fax:703-846-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040397207ND0900X, 207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0126246P05OtherMEDICARE PTAN
VA1295899953Medicaid