Provider Demographics
NPI:1659479178
Name:ALEXANDER, JEFFREY STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEVEN
Last Name:ALEXANDER
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 1:2702 PEMBERTON RIDGE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013
Mailing Address - Country:US
Mailing Address - Phone:410-557-8873
Mailing Address - Fax:410-557-8873
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-901-0301
Practice Address - Fax:443-901-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD044560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD160751100Medicaid
F91116Medicare UPIN
664M175FMedicare PIN