Provider Demographics
NPI:1548269483
Name:WILLIAMS, ALEX OLABODE (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:OLABODE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GRESHAM DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1901
Mailing Address - Country:US
Mailing Address - Phone:757-627-6416
Mailing Address - Fax:757-627-3709
Practice Address - Street 1:400 GRESHAM DR
Practice Address - Street 2:SUITE 303
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1901
Practice Address - Country:US
Practice Address - Phone:757-627-6416
Practice Address - Fax:757-627-3709
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230616207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
40426OtherSENTARA
286272OtherANTHEM
286273OtherANTHEM
100014969OtherRAILROAD MEDICARE
VA5857261Medicaid
100014969OtherRAILROAD MEDICARE
VA100000285Medicare ID - Type Unspecified