Provider Demographics
NPI:1972587178
Name:ALECK, DEBRA J (DPM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:ALECK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3133
Mailing Address - Country:US
Mailing Address - Phone:757-397-3668
Mailing Address - Fax:
Practice Address - Street 1:3511 WESTERN BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3133
Practice Address - Country:US
Practice Address - Phone:757-397-3668
Practice Address - Fax:757-397-5889
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000870213E00000X
TX1119213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9332146Medicaid
VA54 1031782OtherFED TAX ID
VA9332146Medicaid
U34014Medicare UPIN