Provider Demographics
NPI:1952617995
Name:ALEXEEVA, VLADA (MD)
Entity Type:Individual
Prefix:DR
First Name:VLADA
Middle Name:
Last Name:ALEXEEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VLADA
Other - Middle Name:
Other - Last Name:ALEXEEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:31 MARWOOD RD N
Mailing Address - Street 2:B
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1419
Mailing Address - Country:US
Mailing Address - Phone:516-467-4449
Mailing Address - Fax:
Practice Address - Street 1:100 CHARLES LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3631
Practice Address - Country:US
Practice Address - Phone:516-512-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY262201207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program