Provider Demographics
NPI:1912641291
Name:VANCOL, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:VANCOL
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 1:3350 TOLEDO TER APT 104
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1386
Mailing Address - Country:US
Mailing Address - Phone:305-812-2459
Mailing Address - Fax:
Practice Address - Street 1:20500 SENECA MEADOWS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7009
Practice Address - Country:US
Practice Address - Phone:301-916-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program