Provider Demographics
NPI:1134741986
Name:TIBIL, ALEXANDRA LUCIA (MD)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:LUCIA
Last Name:TIBIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 GRIDER STREET, ERIE COUNTY MEDICAL CENTER DAVID K.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER STREET, ERIE COUNTY MEDICAL CENTER DAVID K.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-898-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2023-08-15
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-03-07
Provider Licenses
StateLicense IDTaxonomies
NY324678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine