MEDICARE: ALEXANDRIA HEALTH CARE CENTER, PLLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1922131887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDRIA HEALTH CARE CENTER, PLLC

Provider Business Mailing Address
First Line	:	6303 LITTLE RIVER TPKE STE 160
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-5045
Country	:	US
Telephone Number	:	703-658-2650
Fax Number	:	703-658-2656

Provider Business Practice Location Address
First Line	:	6303 LITTLE RIVER TPKE STE 160
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-5045
Country	:	US
Telephone Number	:	703-658-2650
Fax Number	:	703-658-2656

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. AMBRISH KUMAR GUPTA
Credential	:	M.D.
Telephone Number	:	703-658-2650

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	05/06/2009

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