Provider Demographics
NPI:1639732464
Name:DUFFY, ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DUFFY
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 1:128 COLUMBUS ST APT 403
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-4872
Mailing Address - Country:US
Mailing Address - Phone:609-668-4408
Mailing Address - Fax:
Practice Address - Street 1:135 RUTLEDGE AVE STE 1130
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-4216
Practice Address - Country:US
Practice Address - Phone:843-876-0791
Practice Address - Fax:437-920-5468
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty