Healthcare Provider Details

I. General information

NPI: 1538694203
Provider Name (Legal Business Name): ALEXANDRA ROSE PRZYBYLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEANDRA ROSE CHICO MD

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 ROBIOUS RD STE 100
MIDLOTHIAN VA
23113-5605
US

IV. Provider business mailing address

11601 ROBIOUS RD STE 100
MIDLOTHIAN VA
23113-5605
US

V. Phone/Fax

Practice location:
  • Phone: 804-379-9494
  • Fax:
Mailing address:
  • Phone: 804-379-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101267575
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: