Provider Demographics
NPI:1245076371
Name:LEPAGE-FARRELL, ALEX (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:LEPAGE-FARRELL
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 1:3010 EDEN AVENUE
Mailing Address - Street 2:UNIT 313
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:819-580-1555
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.255892390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMD-0140-9058OtherMEDICAL IDENTIFICATION NUMBER FOR CANADA