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General NPI Number Information
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NPI Number | 1285367706
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Entity Type | Organization
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Legal Business Name | ALICORN INC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 63 1/2 JEFFERSON AVE
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City | SALEM
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State | MA
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Zip | 01970-2975
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Country | US
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Telephone | 202-276-3074
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 ANNANDALE RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3502
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Country | US
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Telephone | 202-276-3074
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PRAVEEN MOOGANUR
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Credential |
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Telephone | 202-276-3074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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