Provider Demographics
NPI:1578630869
Name:GOSPODINOFF, ALEXIA R (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXIA
Middle Name:R
Last Name:GOSPODINOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE #130
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:703-709-9174
Mailing Address - Fax:703-709-9183
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE #130
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-709-9174
Practice Address - Fax:703-709-9183
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055199207RR0500X
MDD0054036207RR0500X
DCMD30046207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH10843Medicare UPIN
VA004935M92Medicare ID - Type Unspecified