Provider Demographics
NPI:1881654192
Name:TAYLOR, ALEX P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:P
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MAJESTIC AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-4055
Mailing Address - Country:US
Mailing Address - Phone:757-622-0453
Mailing Address - Fax:757-622-0455
Practice Address - Street 1:930 MAJESTIC AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4055
Practice Address - Country:US
Practice Address - Phone:757-622-0453
Practice Address - Fax:757-622-0455
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005646375Medicaid
VAVAA103547Medicare PIN
VAH40289Medicare UPIN
VA005646375Medicaid
VAVAA103571Medicare PIN