MEDICARE: ALEXANDER MAXWELL KANDABAROW M.D.

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
1	208600000X	Surgery Physician	00000000	IL
2	208800000X	Urology Physician	036155865	IL
3	208800000X	Urology Physician	125068288	IL
4	208800000X	Urology Physician	0101274595	VA

General Provider Information

NPI Number	:	1649630211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER MAXWELL KANDABAROW M.D.

Provider Business Mailing Address
First Line	:	3475 N BEAUREGARD ST STE 201
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1356
Country	:	US
Telephone Number	:	703-506-8590
Fax Number	:	703-506-8596

Provider Business Practice Location Address
First Line	:	3475 N BEAUREGARD ST STE 201
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1356
Country	:	US
Telephone Number	:	703-506-8590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	05/19/2025

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