Provider Demographics
NPI:1649311861
Name:OCAMPO, ALEXANDER T (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:T
Last Name:OCAMPO
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 1:200 LAWYERS RD. N.W
Mailing Address - Street 2:#1455
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22183-8071
Mailing Address - Country:US
Mailing Address - Phone:703-255-5504
Mailing Address - Fax:703-255-5507
Practice Address - Street 1:360 MAPLE AVE W
Practice Address - Street 2:SUITE F
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5614
Practice Address - Country:US
Practice Address - Phone:703-255-5504
Practice Address - Fax:703-255-5507
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030967207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1491-0001OtherCAREFIRST
VA201793OtherANTHEM
W1H12OtherEMPIRE BLUE CROSS
MDW431-542908-01OtherCAREFIRST
W1H12OtherEMPIRE BLUE CROSS
1491-0001OtherCAREFIRST