Provider Demographics
NPI:1609043678
Name:TABORI, ALEXANDER VINCENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:VINCENT
Last Name:TABORI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:721 N ELM ST
Practice Address - Street 2:STE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3929
Practice Address - Country:US
Practice Address - Phone:336-802-2205
Practice Address - Fax:336-802-2599
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3682103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001138Medicaid
NC2821616Medicare PIN