ALEX P. PAVIDAPHA M.D NPI 1053799585

NPI Information

NPI: 1053799585
Provider Name: ALEX P. PAVIDAPHA, M.D
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

PECOS Registration: Yes

Address:
1801 ROBERT FULTON DRIVE, SUITE 510
RESTON, VA
ZIP 20191
Phone: (703) 783-5355
Get Directions

Alex P. Pavidapha, M.D is a diagnostic radiology radiology in Reston, VA with 9 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Alex P. Pavidapha, M.D NPI is 1053799585. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1801 ROBERT FULTON DRIVE, SUITE 510
RESTON, VA
ZIP 20191-481
Phone: (703) 783-5355

The NPI 1053799585 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/17/2015 and was last updated on 4/9/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	0101273549	VIRGINIA	Yes
2	2085R0202X	Radiology	Diagnostic Radiology	287471	MASSACHUSETTS	No
3	2085R0204X	Radiology	Vascular & Interventional Radiology	287471	MASSACHUSETTS	No
4	2085R0204X	Radiology	Vascular & Interventional Radiology	0101273549	VIRGINIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1053799585	MEDICAID	VIRGINIA
2	30017438440001	MEDICAID	VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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