Healthcare Provider Details

I. General information

NPI: 1790716595
Provider Name (Legal Business Name): ALICE A BASINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1971
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1971
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-9723
  • Fax: 757-668-9724
Mailing address:
  • Phone: 757-668-9723
  • Fax: 757-668-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number0101274000
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: