MEDICARE: ALEXANDRA TILT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	0101275256	VA

General Provider Information

NPI Number	:	1609261924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA TILT M.D.

Provider Business Mailing Address
First Line	:	2829 SHORE DR STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1498
Country	:	US
Telephone Number	:	757-734-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2829 SHORE DR STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1498
Country	:	US
Telephone Number	:	757-734-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	10/17/2022

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