Provider Demographics
NPI:1720171754
Name:ALEXANDRIA INFECTIOUS DISEASE ASSOCIATES PC
Entity Type:Organization
Organization Name:ALEXANDRIA INFECTIOUS DISEASE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:REINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-212-8750
Mailing Address - Street 1:6300 STEVENSON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3554
Mailing Address - Country:US
Mailing Address - Phone:703-212-8750
Mailing Address - Fax:703-212-8752
Practice Address - Street 1:6300 STEVENSON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3554
Practice Address - Country:US
Practice Address - Phone:703-212-8750
Practice Address - Fax:703-212-8752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA582OtherBCBS
DC196364Medicare PIN
VAA582OtherBCBS