NPIMap

Organization Active NPI

Alexandria Lake Ridge Pediatrics

  • Pediatrics Physician
  • Alexandria, VA
National Provider Identifier
1194960252
Registry record updated Dec 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0101038289 Issued in VA
Legal business name
ALEXANDRIA LAKE RIDGE PEDIATRICS
Practice address
1500 N Beauregard St
Suite 200
Alexandria, VA 22311-1723
Phone
(703) 212-6600
Fax
(703) 931-0961
NPI assigned
Dec 3, 2008
Last updated
Dec 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jon M Farber, MD
Title
Treasurer
Phone
(703) 212-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0101038289 VA Primary

Addresses

Primary practice location

1500 N Beauregard St
Suite 200
Alexandria, VA 22311-1723

Mailing address

1707 Osage St
Suite 104
Alexandria, VA 22302-2607
Phone (703) 212-6600

National Provider Directory

National Provider Directory
Tax ID family
Alexandria Lake Ridge Pediatrics5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228262400000",
    "number": "1194960252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 OSAGE ST",
            "address_2": "SUITE 104",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223022607",
            "telephone_number": "703-212-6600",
            "fax_number": "703-931-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N BEAUREGARD ST",
            "address_2": "SUITE 200",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223111723",
            "telephone_number": "703-212-6600",
            "fax_number": "703-931-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXANDRIA LAKE RIDGE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-03",
        "last_updated": "2008-12-03",
        "status": "A",
        "authorized_official_last_name": "FARBER",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "703-212-6600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101038289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.