Provider Demographics
NPI:1841450798
Name:ALEXANDER S. FANGONIL, M.D.PC
Entity type:Organization
Organization Name:ALEXANDER S. FANGONIL, M.D.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:SANSANO
Authorized Official - Last Name:FANGONIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-529-3400
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:DE PAUL BLDG. SUITE 212
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-529-3400
Mailing Address - Fax:202-832-8007
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:DE PAUL BLDG. SUITE 212
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-529-3400
Practice Address - Fax:202-832-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD 5342208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021223800Medicaid
DCB93738Medicare UPIN
DC157674Medicare PIN