MEDICARE: GORDON M ALEXANDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101055246	VA
2	208M00000X	Hospitalist Physician	0101055246	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	175992	OTHER	VA	BCBS

General Provider Information

NPI Number	:	1801895354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON M ALEXANDER MD

Provider Business Mailing Address
First Line	:	200 MEDICAL PARK BLVD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9274
Country	:	US
Telephone Number	:	804-765-5000
Fax Number	:	804-765-5948

Provider Business Practice Location Address
First Line	:	200 MEDICAL PARK BLVD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9274
Country	:	US
Telephone Number	:	804-765-5000
Fax Number	:	804-765-5948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/22/2011

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