Basic Information
| Provider Information | |||||||||
| NPI: | 1598724056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALEXANDRIA FAIRFAX NEUROLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 N BEAUREGARD ST | ||||||||
| Address2: | #300 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038451500 | ||||||||
| FaxNumber: | 7038451300 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 N BEAUREGARD ST | ||||||||
| Address2: | #300 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038451500 | ||||||||
| FaxNumber: | 7038451300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 02/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEDMAN | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7038451599 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | NOT APPLICABLE | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CI8991 | 01 | VA | RAILROAD GROUP # | OTHER | 34244 | 01 | VA | KAISER GROUP # | OTHER |