Provider Demographics
NPI:1558323378
Name:ALEXANDER, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N ELAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1142
Mailing Address - Country:US
Mailing Address - Phone:336-299-3183
Mailing Address - Fax:336-299-6352
Practice Address - Street 1:510 N ELAM AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1150
Practice Address - Country:US
Practice Address - Phone:336-299-3183
Practice Address - Fax:336-299-6352
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790287WMedicaid
NCAA1562037OtherDEA
NCAA1562037OtherDEA