Pavidapha, Alex P.
Pavidapha, Alex P. is an individual health care provider with primary practice located at 1801 Robert Fulton Drive, Suite 510 , Reston VA 20191-5481. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Pavidapha, Alex P. can be contacted via phone (703) 783-5355.Contact Information
Primary practice address
1801 Robert Fulton Drive, Suite 510
Reston VA 20191-5481
Phone: (703) 783-5355
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 0101273549 | Virginia |
Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 287471 | Massachusetts |
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | 287471 | Massachusetts |
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | 0101273549 | Virginia |
Profile Details
NPI number | 1053799585 |
---|---|
LBN Legal business name | Pavidapha, Alex P. |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 17th, 2015 |
Last updated | Jun 3rd, 2024 - about 6 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1053799585 | NPPES |
Virginia | MEDICAID | 1053799585 | |
Virginia | MEDICAID | 30017438440001 |
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