Provider Demographics
NPI:1265503395
Name:DEMOLLES, ALEXANDER HOWARD (DA DOCTOR OF ACUPUN)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:HOWARD
Last Name:DEMOLLES
Suffix:
Gender:M
Credentials:DA DOCTOR OF ACUPUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-2031
Mailing Address - Country:US
Mailing Address - Phone:401-423-0642
Mailing Address - Fax:
Practice Address - Street 1:7610 POST RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3900
Practice Address - Country:US
Practice Address - Phone:401-294-1018
Practice Address - Fax:401-294-1018
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00129171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22021-9Medicare UPIN
RI4900009Medicare UPIN