Healthcare Provider Details

I. General information

NPI: 1164827762
Provider Name (Legal Business Name): GUY DAVID PROSPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 ARLINGTON BLVD STE 210
FALLS CHURCH VA
22042-3000
US

IV. Provider business mailing address

9203C FOREST HAVEN DR
ALEXANDRIA VA
22309-3202
US

V. Phone/Fax

Practice location:
  • Phone: 703-534-1000
  • Fax:
Mailing address:
  • Phone: 301-351-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0092938
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101260176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: