Basic Information
| Provider Information | |||||||||
| NPI: | 1932133832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALFERT | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2722 MERRILEE DR | ||||||||
| Address2: | STE 230 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036984483 | ||||||||
| FaxNumber: | 7035730880 | ||||||||
| Practice Location | |||||||||
| Address1: | 2722 MERRILEE DR | ||||||||
| Address2: | STE 230 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036984483 | ||||||||
| FaxNumber: | 7036982176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 0101232397 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0904X | 0101232397 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | D0088043 | MD | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 0101232397 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 7037382 | 01 | VA | AETNA | OTHER | 432300900 | 05 | MD | MEDICAID | 2961917 | 01 | VA | AETNA HMO | OTHER | BA7792369 | 01 | DEA | OTHER | 0101232397 | 01 | VA | LICENSE | OTHER | 0101253161 | 05 | VA | MEDICAID | 1812057000 | 05 | WV | MEDICAID | 235084 | 01 | VA | AMERIGROUP | OTHER | P00238836 | 01 | VA | MEDICARE ID | OTHER | 300129817 | 01 | DC | MEDICARE ID | OTHER |