Healthcare Provider Details

I. General information

NPI: 1962772541
Provider Name (Legal Business Name): DAVID ALT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

4921 KINGSTON DR
ANNANDALE VA
22003-6150
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-1015
  • Fax: 571-231-6631
Mailing address:
  • Phone: 301-908-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101254407
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101254407
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number0101254407
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: