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General NPI Number Information
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NPI Number | 1710475033
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Entity Type | Individual
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Provider Name | ALEXANDRA MARIE MULLIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 2400 E PARHAM RD
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City | HENRICO
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State | VA
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Zip | 23228-3119
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Country | US
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Telephone | 423-260-0655
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Fax |
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Provider Business Mailing Address
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Address Line | 9101 STONY POINT PKWY APT 1224
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City | RICHMOND
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State | VA
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Zip | 23235-2060
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Country | US
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Telephone | 423-260-0655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 0110-006156
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 0110-006156
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License Number State | VA
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