Provider Demographics
NPI:1154568913
Name:CONSTANTARAS, ALEXANDER A (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:A
Last Name:CONSTANTARAS
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 1:749 CAMINO MIRADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5978
Mailing Address - Country:US
Mailing Address - Phone:505-989-8763
Mailing Address - Fax:
Practice Address - Street 1:749 CAMINO MIRADA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5978
Practice Address - Country:US
Practice Address - Phone:505-989-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86-025207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology