Provider Demographics
NPI:1174812192
Name:MACK, ALEXANDRA SLEDD (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:SLEDD
Last Name:MACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:SLEDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:STE 118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260428207Q00000X
CO0053580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174812192OtherCIGNA
VA1174812192OtherVIRGINIA PREMIER HEALTH PLAN
VA1174812192OtherUSA MANAGED CARE
VA1174812192OtherAETNA
VA1174812192OtherMULTIPLAN
NC1174812192Medicaid
VA1174812192OtherCOVENTRY HEALTH CARE
VA1174812192OtherUNITED HEALTHCARE
VA1174812192OtherTRICARE/CHAMPUS
VA1174812192OtherHUMANA
VA1174812192OtherOPTIMA HEALTH
VA1174812192Medicaid
VA1174812192OtherANTHEM BC/BS
VA1174812192OtherVIRGINIA HEALTH NETWORK
VA1174812192OtherCORVEL
VA1174812192OtherCOVENTRY HEALTH CARE
VA1174812192OtherHUMANA