Provider Demographics
NPI:1750383337
Name:MINARD, ALEXANDER D (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:D
Last Name:MINARD
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST STE 306
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-376-5044
Practice Address - Fax:740-374-1792
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080109208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3004155000Medicaid
OH2395313Medicaid
OH2395313Medicaid
OHP00275892OtherRRMCR
OH000000299961OtherANTHEM
OHP00275892OtherRRMCR
4107283Medicare PIN
OH2395313Medicaid