Healthcare Provider Details

I. General information

NPI: 1306690052
Provider Name (Legal Business Name): ALEXANDRA MICHAELA VAGONIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

1001 E LEIGH ST FL 4
RICHMOND VA
23298-5004
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-3030
  • Fax: 804-828-3045
Mailing address:
  • Phone: 804-828-3030
  • Fax: 804-956-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number1306690052
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: