Provider Demographics
NPI:1841095494
Name:DAWSON, ALEX SHANE
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:SHANE
Last Name:DAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 BALTIMORE ST APT 2H
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2211
Mailing Address - Country:US
Mailing Address - Phone:304-790-0761
Mailing Address - Fax:
Practice Address - Street 1:575 BALTIMORE ST APT 2H
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2211
Practice Address - Country:US
Practice Address - Phone:304-790-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant