Provider Demographics
NPI:1801587522
Name:MAXSTADT, XAVIER EUGENE (LAC)
Entity type:Individual
Prefix:
First Name:XAVIER
Middle Name:EUGENE
Last Name:MAXSTADT
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 COLUMBIA PIKE APT 313
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4523
Mailing Address - Country:US
Mailing Address - Phone:571-274-6421
Mailing Address - Fax:
Practice Address - Street 1:5314 EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4818
Practice Address - Country:US
Practice Address - Phone:571-274-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02964171100000X
VA0121001140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist