Provider Demographics
NPI:1629651393
Name:TOMBERLIN, ALEXANDER GREY
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GREY
Last Name:TOMBERLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EXECUTIVE DR STE H
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4155
Mailing Address - Country:US
Mailing Address - Phone:434-791-1345
Mailing Address - Fax:434-773-6811
Practice Address - Street 1:125 EXECUTIVE DR STE H
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4155
Practice Address - Country:US
Practice Address - Phone:434-791-1345
Practice Address - Fax:434-773-6811
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116035427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine