Healthcare Provider Details

I. General information

NPI: 1306263660
Provider Name (Legal Business Name): ALEX CHARLES ESSENMACHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE
HAMPTON VA
23665-2040
US

IV. Provider business mailing address

77 NEALY AVE
HAMPTON VA
23665-2040
US

V. Phone/Fax

Practice location:
  • Phone: 757-764-6935
  • Fax:
Mailing address:
  • Phone: 757-764-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-46537
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: