Provider Demographics
NPI:1437170305
Name:BORY, ALEXANDER (PHD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BORY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3815
Mailing Address - Country:US
Mailing Address - Phone:540-371-2251
Mailing Address - Fax:540-371-2930
Practice Address - Street 1:1119 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3815
Practice Address - Country:US
Practice Address - Phone:540-371-2251
Practice Address - Fax:540-371-2930
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001956103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00041531OtherRRMC
VA100521OtherBCBS
VA680000675Medicare UPIN