Provider Demographics
NPI:1710319553
Name:PHELPS, ALFRED LORENZO (PA-C)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:LORENZO
Last Name:PHELPS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVENUE, NW
Mailing Address - Street 2:3400
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060
Mailing Address - Country:US
Mailing Address - Phone:202-865-6679
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVENUE, NW
Practice Address - Street 2:SIUTE A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-1183
Practice Address - Fax:202-865-3039
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005138363AS0400X, 363A00000X, 363AM0700X
DCPA030795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical