Provider Demographics
NPI:1447224910
Name:AXELSON, ALAN ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ARTHUR
Last Name:AXELSON
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 1:180 FORT COUCH RD
Mailing Address - Street 2:STE 304
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1041
Mailing Address - Country:US
Mailing Address - Phone:412-831-0355
Mailing Address - Fax:412-854-5152
Practice Address - Street 1:180 FORT COUCH RD
Practice Address - Street 2:STE 304
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1041
Practice Address - Country:US
Practice Address - Phone:412-831-0355
Practice Address - Fax:412-854-5152
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009605E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B37180Medicare UPIN
PAAX120779Medicare ID - Type Unspecified