1851880371 NPI number — ALEXANDRA GILLESPY LORENTSEN MD

Table of content: ALEXANDRA GILLESPY LORENTSEN MD (NPI 1851880371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851880371 NPI number — ALEXANDRA GILLESPY LORENTSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LORENTSEN
Provider First Name:
ALEXANDRA
Provider Middle Name:
GILLESPY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1851880371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CARY PEDIATRIC CENTER
Provider Second Line Business Mailing Address:
1001 CRESENT GREEN DR
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-467-3211
Provider Business Mailing Address Fax Number:
919-467-5315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
APEX PEDIATRIC CENTER
Provider Second Line Business Practice Location Address:
1021 W. WILLIAMS STREET, STE. 105
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-290-1090
Provider Business Practice Location Address Fax Number:
919-290-1086
Provider Enumeration Date:
05/10/2018

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: 208000000X , with the licence number:  2021-01141 , 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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