Provider Demographics
NPI:1639143035
Name:ACLE, ALEJANDRO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:E
Last Name:ACLE
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 1:1018 OLD TIOGA TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814-9605
Mailing Address - Country:US
Mailing Address - Phone:570-864-2066
Mailing Address - Fax:
Practice Address - Street 1:549 EAST FAIR STREET
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815
Practice Address - Country:US
Practice Address - Phone:570-387-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040117L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B42200Medicare UPIN
PA480406Medicare ID - Type Unspecified