Provider Demographics
NPI:1114682234
Name:PETROU, ALEXANDRA (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PETROU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2106
Mailing Address - Country:US
Mailing Address - Phone:732-320-9196
Mailing Address - Fax:877-421-3585
Practice Address - Street 1:34 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2106
Practice Address - Country:US
Practice Address - Phone:732-320-9196
Practice Address - Fax:877-421-3585
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00658900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine