Provider Demographics
NPI:1598920407
Name:KOSMIDIS, ALEXANDER P (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:P
Last Name:KOSMIDIS
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 1:21375 LORAIN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2122
Mailing Address - Country:US
Mailing Address - Phone:440-333-3060
Mailing Address - Fax:440-333-0273
Practice Address - Street 1:21375 LORAIN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2122
Practice Address - Country:US
Practice Address - Phone:440-333-3060
Practice Address - Fax:440-333-0273
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.013326207W00000X
LAMD.204715207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1598920407OtherNPI
OHH368/52Medicare UPIN
LA2155369Medicaid
LA332779YSUJMedicare PIN