Provider Demographics
NPI:1295787133
Name:BRAZALOVICH, ALEXANDER (DO)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:BRAZALOVICH
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 1:33 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9732
Mailing Address - Country:US
Mailing Address - Phone:207-283-2842
Mailing Address - Fax:
Practice Address - Street 1:813 MAIN ST
Practice Address - Street 2:MASSABESIC REGIONAL MEDICAL CENTER
Practice Address - City:WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04087-3006
Practice Address - Country:US
Practice Address - Phone:207-247-6131
Practice Address - Fax:207-247-6675
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1364OtherLICENSE
ME7659431002OtherCIGNA
MEMN3424OtherHARVARD
ME037872OtherBCBS START NUMBER
ME285210099Medicaid
ME285210099Medicaid
MEBRMM7909Medicare ID - Type UnspecifiedMEDICARE
ME285210099Medicaid