Healthcare Provider Details

I. General information

NPI: 1174513436
Provider Name (Legal Business Name): EBEN ALEXANDER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 LANGHORNE RD
LYNCHBURG VA
24501-1424
US

IV. Provider business mailing address

4223 HILTON PL
LYNCHBURG VA
24503-2007
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3920
  • Fax: 434-947-3924
Mailing address:
  • Phone: 434-384-5748
  • Fax: 434-384-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101239440
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number30888
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number58762
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number12520
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: