Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0102037169 | VA |
N | 207Q00000X | Family Doctor | 0102037169 | VA |
NPI | 1407056419 |
---|---|
Provider Name | Mrs. Alexandra Sasha Rupert |
First Address | Alexandria, VA 22304 |
Second Address | Alexandria, VA 22302-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 19/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E76218 | (02) | VA |