Provider Demographics
NPI:1760426241
Name:PATRICK, ALEXANDER M (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:M
Last Name:PATRICK
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 1:7 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4566
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:864-797-6195
Practice Address - Street 1:81 POINTE CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3505
Practice Address - Country:US
Practice Address - Phone:864-232-0321
Practice Address - Fax:864-232-7019
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571004971007OtherBCBS OF SC ID
SC080193482OtherRR MEDICARE
SC1585402OtherCIGNA ID
SC057182Medicaid
SC4263685OtherAETNA ID
SCB922287951Medicare PIN
SC057182Medicaid