Provider Demographics
NPI:1073214854
Name:ALLENDER, ALEX JACOB
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:JACOB
Last Name:ALLENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MAPLEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-1959
Mailing Address - Country:US
Mailing Address - Phone:410-507-8944
Mailing Address - Fax:
Practice Address - Street 1:9501 OLD ANNAPOLIS RD STE 125
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6355
Practice Address - Country:US
Practice Address - Phone:410-997-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program