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NPI Code Detail

MEDICARE: ALEXANDRA MARIE MULLIN PA-C

MEDICARE: ALEXANDRA MARIE MULLIN PA-C
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
1207QA0505XAdult Medicine Physician0110-006156VA
2207RG0300XGeriatric Medicine (Internal Medicine) Physician0110-006156VA

General Provider Information

NPI Number : 1710475033
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA MARIE MULLIN PA-C
Provider Business Mailing Address
First Line : 9101 STONY POINT PKWY APT 1224
Second Line :
City : RICHMOND
State : VA
Zip : 23235-2060
Country : US
Telephone Number : 423-260-0655
Fax Number :
Provider Business Practice Location Address
First Line : 2400 E PARHAM RD
Second Line :
City : HENRICO
State : VA
Zip : 23228-3119
Country : US
Telephone Number : 423-260-0655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2018
Last Update Date : 04/23/2018

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