1629097415 NPI number — DR. SUSAN BRADY ALEXANDER PH.D.

Table of content: DR. SUSAN BRADY ALEXANDER PH.D. (NPI 1629097415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629097415 NPI number — DR. SUSAN BRADY ALEXANDER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
SUSAN
Provider Middle Name:
BRADY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADY
Provider Other First Name:
SUSAN
Provider Other Middle Name:
BUCHANAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629097415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 EXECUTIVE CIR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27511-4586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-460-1414
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 EXECUTIVE CIR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27511-4586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-460-1414
Provider Business Practice Location Address Fax Number:
919-460-0238
Provider Enumeration Date:
07/19/2006

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: 103T00000X , with the licence number:  1408 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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