Healthcare Provider Details

I. General information

NPI: 1861495871
Provider Name (Legal Business Name): STEPHEN W REX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD STE 415
ALEXANDRIA VA
22306-3410
US

IV. Provider business mailing address

8101 HINSON FARM RD STE 415
ALEXANDRIA VA
22306-3410
US

V. Phone/Fax

Practice location:
  • Phone: 703-799-9695
  • Fax: 703-310-4314
Mailing address:
  • Phone: 703-799-9695
  • Fax: 703-310-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101051876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: