Provider Demographics
NPI:1942995980
Name:BULAEVA, ALEKSANDRA (MD)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:
Last Name:BULAEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEKSANDRA
Other - Middle Name:
Other - Last Name:KISELEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 ROSHEHINSKY PREEZD, 1-21
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:RUSSIA
Mailing Address - Zip Code:115191
Mailing Address - Country:RU
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVENUE, HOFHEIMER HALL, 4TH FLOOR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-446-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-11-21
Deactivation Date:2023-11-09
Deactivation Code:
Reactivation Date:2023-11-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program