Provider Demographics
NPI:1790716595
Name:BASINGER, ALICE A (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:BASINGER
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 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1971
Mailing Address - Country:US
Mailing Address - Phone:757-668-9723
Mailing Address - Fax:757-668-9724
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1971
Practice Address - Country:US
Practice Address - Phone:757-668-9723
Practice Address - Fax:757-668-9724
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101274000207SG0202X
TXM3897207SG0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181101003Medicaid
TX181101004OtherCSHCN
TX1750369203OtherGROUP NPI NUMBER
TX181101006OtherCSHCN
TX181101005Medicaid
8L16452Medicare PIN