Provider Demographics
NPI:1780629071
Name:JEREV, ALEXANDAR S (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDAR
Middle Name:S
Last Name:JEREV
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 1:1 TRINITY DR E STE 120
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-8522
Mailing Address - Country:US
Mailing Address - Phone:717-432-5430
Mailing Address - Fax:717-432-9296
Practice Address - Street 1:1 TRINITY DR E STE 120
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-8522
Practice Address - Country:US
Practice Address - Phone:717-432-5430
Practice Address - Fax:717-432-9296
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071769L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001850083Medicaid
H39918Medicare UPIN
H39918Medicare UPIN