Healthcare Provider Details

I. General information

NPI: 1255501417
Provider Name (Legal Business Name): MOSES K ALBERT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAMAKER CT
FAIRFAX VA
22031-2238
US

IV. Provider business mailing address

3020 HAMAKER CT
FAIRFAX VA
22031-2238
US

V. Phone/Fax

Practice location:
  • Phone: 703-849-8036
  • Fax: 703-204-3448
Mailing address:
  • Phone: 703-849-8036
  • Fax: 703-204-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101033804
License Number StateVA

VIII. Authorized Official

Name: MOSES K ALBERT
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 703-849-8036