Provider Demographics
NPI:1245224682
Name:CUTLER, ALEXANDRA S (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:S
Last Name:CUTLER
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 1:302 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2408
Mailing Address - Country:US
Mailing Address - Phone:718-815-1000
Mailing Address - Fax:718-815-8122
Practice Address - Street 1:130 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6362
Practice Address - Country:US
Practice Address - Phone:718-815-1000
Practice Address - Fax:718-815-8122
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235077-1207L00000X
WV22549207L00000X
NY235077207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV20554238700OtherBRICKSTREET GROUP
WV001888866OtherMSBCBC
WV1070936OtherBRICKSTREET
WV3810007131Medicaid
WVP00377019OtherRR MEDICARE
WV001907643OtherMSBCBS GROUP
WVDF0767OtherRR MEDICARE
WV3810006746Medicaid
WV001907643OtherMSBCBS GROUP
WVP00377019OtherRR MEDICARE