Provider Demographics
NPI:1144648502
Name:LIGHT, ALEXIS D (MD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:D
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S WASHINGTON ST STE 330
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4252
Mailing Address - Country:US
Mailing Address - Phone:703-940-3364
Mailing Address - Fax:703-717-4055
Practice Address - Street 1:700 S WASHINGTON ST STE 330
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4252
Practice Address - Country:US
Practice Address - Phone:703-940-3364
Practice Address - Fax:703-717-4055
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD045985207VX0000X
VA0101264717207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101264717OtherSTATE LICENSE