Provider Demographics
NPI:1811024631
Name:MOUTSATSOS, ALEXIA (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:
Last Name:MOUTSATSOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 SILVERSIDE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1774
Mailing Address - Country:US
Mailing Address - Phone:302-798-0666
Mailing Address - Fax:302-798-4905
Practice Address - Street 1:B 89 OMEGA DRIVE
Practice Address - Street 2:BLDG. B, SUITE 89
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-0000
Practice Address - Country:US
Practice Address - Phone:302-738-5500
Practice Address - Fax:302-738-9449
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC7-0002948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
022842T76Medicare UPIN