MEDICARE: BEAUREGARD MEDICAL CENTER, LTD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207K00000X	Allergy & Immunology Physician
2	207R00000X	Internal Medicine Physician
3	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2156	OTHER		CARE FIRST GROUP #

General Provider Information

NPI Number	:	1780708024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUREGARD MEDICAL CENTER, LTD

Provider Business Mailing Address
First Line	:	3450 N BEAUREGARD ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1200
Country	:	US
Telephone Number	:	703-820-7000
Fax Number	:	703-820-5564

Provider Business Practice Location Address
First Line	:	3450 N BEAUREGARD ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1200
Country	:	US
Telephone Number	:	703-820-7000
Fax Number	:	703-820-5564

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN S PULIZZI JR.
Credential	:
Telephone Number	:	703-824-9397

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	11/19/2009

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1134122161 — RODRIGO C HURTADO M.D.
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1366495228 — CRISTIAN RODRIGUEZ M.D.
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1023381506 — SANJEEV KOHLI, MD PC
Practice Location Address:

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Practice Phone: 703-820-7000
Practice Fax: 703-820-5564

Directions to “BEAUREGARD MEDICAL CENTER, LTD ” Practice Location

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