Healthcare Provider Details

I. General information

NPI: 1245285659
Provider Name (Legal Business Name): ALYSSA M ABO-LUBITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/05/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PM PEDIATRICS 11056 ROUTE 29
FAIRFAX VA
22030
US

IV. Provider business mailing address

6683 MCLEAN DR
MC LEAN VA
22101-4002
US

V. Phone/Fax

Practice location:
  • Phone: 703-552-5437
  • Fax:
Mailing address:
  • Phone: 610-393-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD041285
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number227865
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: