Provider Demographics
NPI:1972036218
Name:CARRASQUER, C. ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:ALEXANDER
Last Name:CARRASQUER
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 1:1808 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1041
Mailing Address - Country:US
Mailing Address - Phone:502-387-3268
Mailing Address - Fax:
Practice Address - Street 1:2401 TERRA CROSSING BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5395
Practice Address - Country:US
Practice Address - Phone:502-210-4600
Practice Address - Fax:502-210-4605
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53367208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300051639Medicaid
KY7100743060Medicaid