Healthcare Provider Details

I. General information

NPI: 1578053849
Provider Name (Legal Business Name): ALLISON ANNE HAUPT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2018
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 TRAFORD LN STE 1
SPRINGFIELD VA
22152-1662
US

IV. Provider business mailing address

8316 TRAFORD LN STE 1
SPRINGFIELD VA
22152-1662
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101273247
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: