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General NPI Number Information
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NPI Number | 1053799585
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Entity Type | Individual
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Provider Name | ALEX P. PAVIDAPHA M.D
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Gender | Male
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Dates
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Enumeration Date | 05/17/2015
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1801 ROBERT FULTON DRIVE, SUITE 510
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City | RESTON
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State | VA
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Zip | 20191-5481
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Country | US
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Telephone | 703-783-5355
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Fax |
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL STREET, NW, SUITE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101273549
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 287471
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 287471
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 0101273549
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License Number State | VA
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