Provider Demographics
NPI:1679530414
Name:DR. T. ALEXANDER
Entity Type:Organization
Organization Name:DR. T. ALEXANDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CERIMELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-4515
Mailing Address - Street 1:4129 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9527
Mailing Address - Country:US
Mailing Address - Phone:330-758-4515
Mailing Address - Fax:330-758-5121
Practice Address - Street 1:4129 PEBBLE BEACH DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9527
Practice Address - Country:US
Practice Address - Phone:330-758-4515
Practice Address - Fax:330-758-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002510208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E00621Medicare UPIN