Provider Demographics
NPI:1952373409
Name:WYNN, ALANCIA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:ALANCIA
Middle Name:CHRISTINE
Last Name:WYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-560-0300
Mailing Address - Fax:703-560-8679
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 234
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-560-0300
Practice Address - Fax:703-560-8679
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G67657Medicare UPIN
131501ZAQUMedicare PIN