Provider Demographics
NPI:1497351167
Name:SALISBURY, ALEXANDRA (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:SALISBURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:11934 W BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1100
Mailing Address - Country:US
Mailing Address - Phone:804-423-2100
Mailing Address - Fax:804-716-5057
Practice Address - Street 1:11934 W BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1100
Practice Address - Country:US
Practice Address - Phone:804-423-2100
Practice Address - Fax:804-716-5057
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026051-01363A00000X
PAMA062054363A00000X
VA0110007549363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant