Provider Demographics
NPI:1205008984
Name:DE GOLOVINE, ALEKSANDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEKSANDRA
Middle Name:M
Last Name:DE GOLOVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEKSANDRA
Other - Middle Name:M
Other - Last Name:DYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:803 BRANARD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4913
Mailing Address - Country:US
Mailing Address - Phone:314-255-9242
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-794-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9534207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283217201Medicaid
TXTXB132342Medicare PIN