Provider Demographics
NPI:1053328120
Name:ALEXANDER, JAMILAH ALI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JAMILAH
Middle Name:ALI
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:LEE
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:610 PROFESSIONAL DR STE 255
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3463
Mailing Address - Country:US
Mailing Address - Phone:240-683-6202
Mailing Address - Fax:240-683-6203
Practice Address - Street 1:610 PROFESSIONAL DR STE 255
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3463
Practice Address - Country:US
Practice Address - Phone:240-683-6202
Practice Address - Fax:240-683-6203
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPA99358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant