Healthcare Provider Details

I. General information

NPI: 1659863025
Provider Name (Legal Business Name): OZLEM GOKER-ALPAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 PENDER DR STE 170
FAIRFAX VA
22030-6066
US

IV. Provider business mailing address

3702 PENDER DR STE 170
FAIRFAX VA
22030-6066
US

V. Phone/Fax

Practice location:
  • Phone: 703-261-6220
  • Fax: 703-991-6592
Mailing address:
  • Phone: 703-261-6220
  • Fax: 703-991-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number0101247355
License Number StateVA

VIII. Authorized Official

Name: UYENSA BEESE
Title or Position: PRACTICE ADMINITRATIVE
Credential:
Phone: 571-529-6805