Provider Demographics
NPI:1730460049
Name:ALEXANDRIA MEDICAL ASSOCIATION PA
Entity Type:Organization
Organization Name:ALEXANDRIA MEDICAL ASSOCIATION PA
Other - Org Name:ALEXANDRIA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:MAHDY
Authorized Official - Last Name:ABDELMOULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-205-2080
Mailing Address - Street 1:1836 SNAKE RIVER RD STE C
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7753
Mailing Address - Country:US
Mailing Address - Phone:281-578-9000
Mailing Address - Fax:281-578-9004
Practice Address - Street 1:1836 SNAKE RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7753
Practice Address - Country:US
Practice Address - Phone:281-578-9000
Practice Address - Fax:281-578-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318749401Medicaid
TXTXB139225Medicare PIN