Healthcare Provider Details

I. General information

NPI: 1568148997
Provider Name (Legal Business Name): AMIR ALEXANDER HOBSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS ROAD INOVA FAIRFAX MEDICAL CAMPUS-GRADUATE MEDICAL EDUCATION
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

3300 GALLOWS ROAD INOVA FAIRFAX MEDICAL CAMPUS-GRADUATE MEDICAL EDUCATION
FALLS CHURCH VA
22042
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-3582
  • Fax:
Mailing address:
  • Phone: 703-776-3582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116037998
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: