Provider Demographics
NPI:1164404877
Name:ALEXANDROV, TODOR D (MD)
Entity Type:Individual
Prefix:DR
First Name:TODOR
Middle Name:D
Last Name:ALEXANDROV
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8747
Mailing Address - Fax:765-983-3008
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-935-8747
Practice Address - Fax:765-983-3008
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11114800207L00000X
IN01059642A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2670793Medicaid
IN000000906091OtherANTHEM (REID PHYSICIAN ASSOCIATES, INC.)
IN200801840Medicaid
IN000000906091OtherANTHEM (REID PHYSICIAN ASSOCIATES, INC.)