Provider Demographics
NPI:1174185896
Name:ALEX, PRIYA SUSAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:SUSAN
Last Name:ALEX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-2223
Mailing Address - Country:US
Mailing Address - Phone:812-295-2812
Mailing Address - Fax:812-996-5426
Practice Address - Street 1:105 COOPER ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-2223
Practice Address - Country:US
Practice Address - Phone:812-295-2812
Practice Address - Fax:812-996-5426
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01088346A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine