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General NPI Number Information
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NPI Number | 1114676822
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Entity Type | Individual
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Provider Name | ALEXANDRA MOUNTFORD
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Gender | Female
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Dates
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Enumeration Date | 03/21/2022
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 3500 OLD WASHINGTON RD STE 101
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City | WALDORF
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State | MD
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Zip | 20602-3205
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Country | US
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Telephone | 301-885-5020
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Fax | 240-419-5217
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Provider Business Mailing Address
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Address Line | 3500 OLD WASHINGTON RD STE 101
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City | WALDORF
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State | MD
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Zip | 20602-3205
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Country | US
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Telephone | 301-885-5020
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Fax | 240-419-5217
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | AC004176
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AC004175
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License Number State | MD
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