MEDICARE: ALEXANDRIA MEDICAL CENTER, INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1740822246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDRIA MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	3606 FOREST DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1005
Country	:	US
Telephone Number	:	571-685-2015
Fax Number	:	571-685-2016

Provider Business Practice Location Address
First Line	:	3606 FOREST DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1005
Country	:	US
Telephone Number	:	571-685-2015
Fax Number	:	571-685-2016

Authorized Official
Title or Position	:	OWNER
Name	:	AHMED ELEBIARY
Credential	:	MD
Telephone Number	:	703-705-9500

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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