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General NPI Number Information
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NPI Number | 1407056419
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Entity Type | Individual
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Provider Name | ALEXANDRA SASHA RUPERT D.O.,
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 1225 MARTHA CUSTIS DR SUITE C-7
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City | ALEXANDRIA
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State | VA
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Zip | 22302-2000
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Country | US
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Telephone | 703-998-6760
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Fax | 703-998-2389
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Provider Business Mailing Address
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Address Line | 1225 MARTHA CUSTIS DRIVE SUITE C-7
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City | ALEXANDRIA
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State | VA
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Zip | 22304
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Country | US
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Telephone | 703-998-6760
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Fax | 703-998-2389
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 0102037169
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102037169
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License Number State | VA
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