Provider Demographics
NPI:1407369192
Name:MIDOLO-CLEVELAND, ALEXANDER VICTOR (PA-S)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:VICTOR
Last Name:MIDOLO-CLEVELAND
Suffix:
Gender:M
Credentials:PA-S
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:40 S 44TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2939
Mailing Address - Country:US
Mailing Address - Phone:607-768-0183
Mailing Address - Fax:
Practice Address - Street 1:40 S 44TH ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2939
Practice Address - Country:US
Practice Address - Phone:607-768-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant