Provider Demographics
NPI:1700373123
Name:ALEXANDER, EBERE LUCKY (MD)
Entity Type:Individual
Prefix:
First Name:EBERE
Middle Name:LUCKY
Last Name:ALEXANDER
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 1:1101 MARKET ST FL 19
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2926
Mailing Address - Country:US
Mailing Address - Phone:856-922-9897
Mailing Address - Fax:
Practice Address - Street 1:435 HURFFVILLE CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2453
Practice Address - Country:US
Practice Address - Phone:856-513-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.141377207R00000X
NJ25MA12005900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program