Provider Demographics
NPI:1437175668
Name:KRUPNICK, ALEXANDER S (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:S
Last Name:KRUPNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W REDWOOD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1708
Mailing Address - Country:US
Mailing Address - Phone:667-214-1720
Mailing Address - Fax:410-706-6976
Practice Address - Street 1:419 W REDWOOD ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-7003
Practice Address - Country:US
Practice Address - Phone:410-328-5300
Practice Address - Fax:410-328-5147
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004009699208G00000X
VA0101261422208G00000X
MDD89214208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO821320412Medicaid
IL$$$$$$$$$Medicaid
MO821320412Medicare PIN