Healthcare Provider Details

I. General information

NPI: 1710319553
Provider Name (Legal Business Name): ALFRED LORENZO PHELPS P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2013
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVENUE, NW SIUTE A
WASHINGTON DC
20060
US

IV. Provider business mailing address

2041 GEORGIA AVENUE, NW 3400
WASHINGTON DC
20060
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-1183
  • Fax: 202-865-3039
Mailing address:
  • Phone: 202-865-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0005138
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA030795
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0005138
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005138
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: