Provider Demographics
NPI:1598874042
Name:HAGEBOUTROS, ALEXANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:HAGEBOUTROS
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 1:401 HADDON AVE
Mailing Address - Street 2:E&R BUILDING 270
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1505
Mailing Address - Country:US
Mailing Address - Phone:856-963-3572
Mailing Address - Fax:856-338-9211
Practice Address - Street 1:900 CENTENNIAL BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4689
Practice Address - Country:US
Practice Address - Phone:856-325-6750
Practice Address - Fax:856-325-6777
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60394207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0475739OtherAETNA
NJ6234704Medicaid
P441764OtherOXFORD
14822OtherUNIVERSITY HEALTHPLAN
1260900OtherUNITED HEALTHCARE
110115409OtherRR MEDICARE
3521183OtherCIGNA
3K5923OtherHEALTHNET
PA500004OtherPA BLUE SHIELD
1051788OtherHORIZON NJ HEALTH
F89401Medicare UPIN
110115409OtherRR MEDICARE