Provider Demographics
NPI:1770733008
Name:LANDEN, ALEXANDRA E (DO)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:E
Last Name:LANDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 KING RD
Mailing Address - Street 2:
Mailing Address - City:IMMACULATA
Mailing Address - State:PA
Mailing Address - Zip Code:19345-9903
Mailing Address - Country:US
Mailing Address - Phone:610-647-4400
Mailing Address - Fax:
Practice Address - Street 1:1145 KING RD
Practice Address - Street 2:
Practice Address - City:IMMACULATA
Practice Address - State:PA
Practice Address - Zip Code:19345-9903
Practice Address - Country:US
Practice Address - Phone:610-647-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0165702084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028920260001Medicaid
NJ0277614Medicaid
PA1028920260001Medicaid