Basic Information
Provider Information | |||||||||
NPI: | 1538714753 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CARTER | ||||||||
FirstName: | ALEXANDRA | ||||||||
MiddleName: | LEWIS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LEWIS | ||||||||
OtherFirstName: | MARY | ||||||||
OtherMiddleName: | ALEXANDRA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | VCUHS GMEA | ||||||||
Address2: | BOX 980257 | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232980257 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8048289783 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | VCUHS DEPARTMENT OF PSYCHIATRY, 980710 | ||||||||
Address2: | 1208 E. MARSHALL STREET | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232980710 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8048287912 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/05/2019 | ||||||||
LastUpdateDate: | 03/22/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/22/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 1538714753 | VA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 390200000X |   |   | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.