Provider Demographics
NPI:1790738029
Name:ALCOX, MELISSA L (PA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:ALCOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6160 KEMPSVILLE CIR
Mailing Address - Street 2:SUITE 200 A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3933
Mailing Address - Country:US
Mailing Address - Phone:757-622-6315
Mailing Address - Fax:757-625-6940
Practice Address - Street 1:6161 KEMPSVILLE CIRCLE
Practice Address - Street 2:SUITE 345
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-622-6315
Practice Address - Fax:757-622-6940
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10026003POtherOPTIMA HEALTH
VAP00462147OtherRR MEDICARE
VA016362P05OtherMEDICARE PTAN
VA1790738029Medicaid
VA016362P05OtherMEDICARE PTAN