Provider Demographics
NPI:1831184936
Name:LABOVITZ, ALEXANDRA E (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:E
Last Name:LABOVITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:BUILDING #10
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-438-6888
Mailing Address - Fax:401-434-1285
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BUILDING #10
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-438-6888
Practice Address - Fax:401-434-1285
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46661208000000X
RIMD12952208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34492000Medicaid
WI34492000Medicaid
WII05680Medicare UPIN