Healthcare Provider Details

I. General information

NPI: 1285138792
Provider Name (Legal Business Name): ALEX CHUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44045 RIVERSIDE PKWY STE 100
LEESBURG VA
20176-5101
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-6000
  • Fax: 703-858-6900
Mailing address:
  • Phone: 703-776-2346
  • Fax: 703-776-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101274655
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101274655
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: