1225410772 NPI number — DAVID I ALEXANDER

Table of content: DAVID I ALEXANDER (NPI 1225410772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225410772 NPI number — DAVID I ALEXANDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
DAVID
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225410772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 CLARKE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21701-6529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-360-1460
Provider Business Mailing Address Fax Number:
301-360-1403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CLARKE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21701-6529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-360-1460
Provider Business Practice Location Address Fax Number:
301-360-1403
Provider Enumeration Date:
06/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  01373 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: SLPAUD00219027 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: A.01971 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A.01971 . This is a "OHIO AUDIOLOGY LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 01373 . This is a "MARYLAND BOARD OF AUDIOLOGISTS, HEARING AID DISPENSERS & SPEECH-LANGUAGE PATHOLO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: SLPAUD00219027 . This is a "KENTUCKY AUDIOLOGY LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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