Healthcare Provider Details

I. General information

NPI: 1801895354
Provider Name (Legal Business Name): GORDON M ALEXANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK BLVD
PETERSBURG VA
23805-9274
US

IV. Provider business mailing address

200 MEDICAL PARK BLVD
PETERSBURG VA
23805-9274
US

V. Phone/Fax

Practice location:
  • Phone: 804-765-5000
  • Fax: 804-765-5948
Mailing address:
  • Phone: 804-765-5000
  • Fax: 804-765-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101055246
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101055246
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: