Provider Demographics
NPI:1992855787
Name:ALEXANDER, GREGG M (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:M
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PARK AVE.
Mailing Address - Street 2:SUITE. 210
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 PARK AVE STE 210
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1121
Practice Address - Country:US
Practice Address - Phone:740-845-7720
Practice Address - Fax:740-845-7721
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.005421208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2026971Medicaid