Provider Demographics
NPI:1760493977
Name:ALEXANDER, CONSTANCE JEANETTE (M D)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:JEANETTE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5983
Mailing Address - Country:US
Mailing Address - Phone:843-556-8177
Mailing Address - Fax:843-571-2742
Practice Address - Street 1:1616 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5902
Practice Address - Country:US
Practice Address - Phone:843-556-8177
Practice Address - Fax:843-571-2742
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC220982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
494387OtherVALUEOPTIONS
H32180Medicare UPIN
494387OtherVALUEOPTIONS
SCP00367321Medicare ID - Type UnspecifiedMEDICARE RAILROAD
SCH321808854Medicare PIN