Healthcare Provider Details

I. General information

NPI: 1730116575
Provider Name (Legal Business Name): ALOK RUSTOGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46090 LAKE CENTER PLZ 201
POTOMAC FALLS VA
20165-5876
US

IV. Provider business mailing address

46090 LAKE CENTER PLZ 201
POTOMAC FALLS VA
20165-5876
US

V. Phone/Fax

Practice location:
  • Phone: 703-489-0508
  • Fax:
Mailing address:
  • Phone: 703-489-0508
  • Fax: 703-468-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number0101236706
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: