Provider Demographics
NPI:1134100332
Name:MESROBIAN, ALEXANDER L (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:L
Last Name:MESROBIAN
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 1:35 MILES ST
Mailing Address - Street 2:MILES MEDICAL GROUP EMERGENCY DEPT
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4047
Mailing Address - Country:US
Mailing Address - Phone:207-563-4521
Mailing Address - Fax:207-563-3717
Practice Address - Street 1:35 MILES ST
Practice Address - Street 2:MILES MEDICAL GROUP EMERGENCY DEPT
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4047
Practice Address - Country:US
Practice Address - Phone:207-563-4521
Practice Address - Fax:207-563-3717
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012127207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM0552Medicare PIN
A68220Medicare UPIN