Healthcare Provider Details

I. General information

NPI: 1366779837
Provider Name (Legal Business Name): MICHAEL ANTHONY ALEXANDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9175 STAPLES MILL RD
HENRICO VA
23228-2027
US

IV. Provider business mailing address

PO BOX 2255
KILMARNOCK VA
22482-2255
US

V. Phone/Fax

Practice location:
  • Phone: 804-944-4576
  • Fax: 804-944-4534
Mailing address:
  • Phone: 804-435-8570
  • Fax: 804-435-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102202758
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: