Provider Demographics
NPI:1548358815
Name:ALEXANDRIA LAKE RIDGE PEDIATRICS
Entity type:Organization
Organization Name:ALEXANDRIA LAKE RIDGE PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-212-6600
Mailing Address - Street 1:1500 N BEAUREGARD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1723
Mailing Address - Country:US
Mailing Address - Phone:703-212-6600
Mailing Address - Fax:703-931-0961
Practice Address - Street 1:1500 N BEAUREGARD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1723
Practice Address - Country:US
Practice Address - Phone:703-212-6600
Practice Address - Fax:703-931-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty