Healthcare Provider Details

I. General information

NPI: 1114983004
Provider Name (Legal Business Name): ALAN J PLOTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 COMMERCE PARK DR LL4
RESTON VA
20191-1555
US

IV. Provider business mailing address

11440 COMMERCE PARK DR LL4
RESTON VA
20191-1555
US

V. Phone/Fax

Practice location:
  • Phone: 703-766-2650
  • Fax: 703-766-2654
Mailing address:
  • Phone: 703-766-2650
  • Fax: 703-766-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101048250
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: