Provider Demographics
NPI:1316943947
Name:LALOS, ALEXANDER T (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:T
Last Name:LALOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:POB SOUTH 215
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-877-9824
Mailing Address - Fax:855-778-6890
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:POB SOUTH 215
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-9824
Practice Address - Fax:855-778-6890
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044410L207RG0100X
MDD0079134207RT0003X
DCMD042763207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001249295Medicaid
PA001249295Medicaid
PA680820M0JMedicare ID - Type Unspecified