Provider Demographics
NPI:1386638807
Name:ALEXANDER, EDWARD LEE III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEE
Last Name:ALEXANDER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4158
Mailing Address - Country:US
Mailing Address - Phone:302-674-4070
Mailing Address - Fax:302-672-2315
Practice Address - Street 1:724 S NEW ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3540
Practice Address - Country:US
Practice Address - Phone:302-674-4070
Practice Address - Fax:302-672-2315
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002593208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000168501Medicaid
DE510385649OtherDE BCBS
DE116849E63Medicare ID - Type Unspecified
DE0000168501Medicaid