Provider Demographics
NPI:1720006588
Name:GRIFFIN, ALESIA WRIGHT (MD)
Entity Type:Individual
Prefix:
First Name:ALESIA
Middle Name:WRIGHT
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13129
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-0129
Mailing Address - Country:US
Mailing Address - Phone:757-366-0692
Mailing Address - Fax:757-366-9118
Practice Address - Street 1:1413 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8134
Practice Address - Country:US
Practice Address - Phone:757-366-0692
Practice Address - Fax:757-366-9118
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA126262OtherOPTIMA
VA010792203OtherCIGNA
VA010792203OtherMAIL HANDLERS
VA010220157Medicaid
VA010792203OtherHEALTH NET
VA5996247OtherGHI
VA010792203OtherVIRGINIA HEALTH NETWORK
VA7156229OtherAETNA
VA237237OtherANTHEM
VA010792203OtherCIGNA
VA010792203OtherMAIL HANDLERS
VAP00265761Medicare ID - Type UnspecifiedRAILROAD MEDICARE