Provider Demographics
NPI:1033462684
Name:ALEXIADIS, VARVARA (MD)
Entity Type:Individual
Prefix:
First Name:VARVARA
Middle Name:
Last Name:ALEXIADIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MERRICK RD
Mailing Address - Street 2:STE 403
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5254
Mailing Address - Country:US
Mailing Address - Phone:516-536-3700
Mailing Address - Fax:516-536-4309
Practice Address - Street 1:242 MERRICK RD
Practice Address - Street 2:STE 403
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5254
Practice Address - Country:US
Practice Address - Phone:516-536-3700
Practice Address - Fax:516-536-4309
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268352207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism