Provider Demographics
NPI:1265687230
Name:MCCOLLUM, ALEXANDRA DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:DAWN
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:145 HENRY ST
Mailing Address - Street 2:ST 1G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2526
Mailing Address - Country:US
Mailing Address - Phone:718-858-4924
Mailing Address - Fax:
Practice Address - Street 1:506 6TH STREET
Practice Address - Street 2:RM 506 DEPT. OF PEDIATRICS, NYM
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2530631208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics