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General NPI Number Information
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NPI Number | 1922495639
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Entity Type | Individual
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Provider Name | ALEXANDRA LOUISE GANNON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 12011 LEE JACKSON MEMORIAL HIGHWAY SUITE 302
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City | FAIR OAKS
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State | VA
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Zip | 22033
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Country | US
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Telephone | 703-246-0500
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Fax | 855-473-0122
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Provider Business Mailing Address
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Address Line | 9600 BLACKWELL RD STE 500
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City | ROCKVILLE
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State | MD
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Zip | 20850-3783
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Country | US
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Telephone |
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Fax | 855-473-0122
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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 | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 0101275640
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License Number State | VA
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