Healthcare Provider Details

I. General information

NPI: 1467895839
Provider Name (Legal Business Name): ALICE R EDWARDS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 KEMPSVILLE CIR STE 315
NORFOLK VA
23502-3935
US

IV. Provider business mailing address

675 NELSON RISING LN
SAN FRANCISCO CA
94143-0003
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-5400
  • Fax: 757-461-3305
Mailing address:
  • Phone:
  • Fax: 631-444-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0102208982
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: