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NPI Code Detail

MEDICARE: ALEXANDRA ROSA CLARK

MEDICARE: ALEXANDRA ROSA CLARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1013841063
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA ROSA CLARK
Provider Business Mailing Address
First Line : 300 KIMBERLY WOODS CT
Second Line :
City : FT WASHINGTON
State : MD
Zip : 20744-5915
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 45085 UNIVERSITY DR
Second Line :
City : ASHBURN
State : VA
Zip : 20147-2766
Country : US
Telephone Number : 571-553-0138
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2026
Last Update Date : 06/12/2026

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Directions to “ ALEXANDRA ROSA CLARK ” Practice Location

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