Individual
ALEX P. PAVIDAPHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1801 ROBERT FULTON DRIVE, SUITE 510, RESTON, VA 20191-5481
(703) 783-5355
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101273549
VA
2085R0202X
Diagnostic Radiology Physician
287471
MA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
0101273549
VA
2085R0204X
Vascular & Interventional Radiology Physician
287471
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053799585
—
VA
05
—
30017438440001
—
VA
Enumeration date
05/17/2015
Last updated
06/03/2024
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