Healthcare Provider Details

I. General information

NPI: 1922048230
Provider Name (Legal Business Name): ALEXANDRIA PERINATAL DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY ROAD INOVA ALEXANDRIA HOSPITAL DIAGNOSTIC CENTER
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

2876 GUARDIAN LANE
VIRGINIA BEACH VA
23452-7327
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-7868
  • Fax: 703-504-7733
Mailing address:
  • Phone: 757-463-5240
  • Fax: 757-463-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH H KOZLOFF
Title or Position: ADMINISTRATOR INOVA ALEXANDRIA HOSP
Credential: FACHE
Phone: 703-504-3167