Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101263595 | VA |
N | 207YS0123X | Facial Plastic Surgeon | 0101263595 | VA |
NPI | 1578531919 |
---|---|
Provider Name | Dr. Alicia Ruth Sanderson |
First Address | Fairfax Station, VA 22039-2532 |
Second Address | Alexandria, VA 22306-3154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 13/01/2020 |