Provider Demographics
NPI:1508839846
Name:BUSTAMANTE, ALEXANDER I (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:I
Last Name:BUSTAMANTE
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 1:9057 JOHN SUTHERLAND LN
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-3474
Mailing Address - Country:US
Mailing Address - Phone:703-657-9504
Mailing Address - Fax:
Practice Address - Street 1:9530 COSNER DR STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7760
Practice Address - Country:US
Practice Address - Phone:540-373-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235018207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease