Individual
ALEX DERTAD MANGUIKIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
9936 MAIN ST, FAIRFAX, VA 22031-3901
(703) 591-4884
Mailing address
9936 MAIN ST, FAIRFAX, VA 22031-3901
(703) 591-4884
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101253390
VA
Other
Enumeration date
05/18/2009
Last updated
03/19/2013
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