Provider Demographics
NPI:1952572851
Name:VOGL, ALEXIS JACQUELINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:JACQUELINE
Last Name:VOGL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43191 THISTLEDOWN TER
Mailing Address - Street 2:APT 430
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4080
Mailing Address - Country:US
Mailing Address - Phone:703-867-9561
Mailing Address - Fax:
Practice Address - Street 1:19465 DEERFIELD AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-1701
Practice Address - Country:US
Practice Address - Phone:703-723-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MC10194OtherMEDICARE INDIVIDUAL PTAN