Provider Demographics
NPI:1932328259
Name:CAILLAT, ALEXANDRE W (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:W
Last Name:CAILLAT
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-248-4413
Mailing Address - Fax:
Practice Address - Street 1:106 W MEDICAL PARK DR STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6854
Practice Address - Country:US
Practice Address - Phone:336-248-4413
Practice Address - Fax:336-248-6260
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57010681208800000X
NC2010-00548208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915016Medicaid
NC2076713Medicare PIN