Provider Demographics
NPI:1093741993
Name:ALEXANDER, ELISHA (IDC US NAVY)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:IDC US NAVY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 RENFREW ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8915
Mailing Address - Country:US
Mailing Address - Phone:757-467-0561
Mailing Address - Fax:757-443-5706
Practice Address - Street 1:1959 MORRIS ST
Practice Address - Street 2:SUITE 120 BLDG Z101
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-3427
Practice Address - Country:US
Practice Address - Phone:757-443-0002
Practice Address - Fax:757-443-5607
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman