Provider Demographics
NPI:1003812132
Name:SPASIC, ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:SPASIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BROOKWOOD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9142
Mailing Address - Country:US
Mailing Address - Phone:717-258-0099
Mailing Address - Fax:717-258-0085
Practice Address - Street 1:19 BROOKWOOD AVE STE 104
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9142
Practice Address - Country:US
Practice Address - Phone:717-258-0099
Practice Address - Fax:717-258-0085
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-064519-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012106780001Medicaid
PAMD-064519-LOtherPA LICENSE NUMBER
PAMD-064519-LOtherPA LICENSE NUMBER
PA1012106780001Medicaid