Provider Demographics
NPI:1568444396
Name:DEVER, ALEXANDER I III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:I
Last Name:DEVER
Suffix:III
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 1:1500 SHALLCROSS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3037
Mailing Address - Country:US
Mailing Address - Phone:302-421-9330
Mailing Address - Fax:302-475-6744
Practice Address - Street 1:1500 SHALLCROSS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3037
Practice Address - Country:US
Practice Address - Phone:302-421-9330
Practice Address - Fax:302-475-6744
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00031232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC1-0003123OtherM.D. LICENSE
DE000331402Medicaid
DE589890Medicare PIN
DE000331402Medicaid