Healthcare Provider Details

I. General information

NPI: 1720983927
Provider Name (Legal Business Name): JOE ALEXANDER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44680 PROVINCETOWN DR
ASHBURN VA
20147-5557
US

IV. Provider business mailing address

44680 PROVINCETOWN DR
ASHBURN VA
20147-5557
US

V. Phone/Fax

Practice location:
  • Phone: 914-886-8264
  • Fax:
Mailing address:
  • Phone: 914-886-8264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29818
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: