Provider Demographics
NPI:1043570294
Name:ALEXANDER, MARY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 758963
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8963
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:2199 OLD BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2911
Practice Address - Country:US
Practice Address - Phone:703-357-9707
Practice Address - Fax:703-357-9708
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVL709AMedicare PIN
VA415020YWAUMedicare PIN