Provider Demographics
NPI:1093846651
Name:VASILE, ALEXANDRU LUCIAN (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRU
Middle Name:LUCIAN
Last Name:VASILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-1325
Mailing Address - Country:US
Mailing Address - Phone:314-512-7800
Mailing Address - Fax:
Practice Address - Street 1:1901 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-1325
Practice Address - Country:US
Practice Address - Phone:314-512-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4258282084P0800X, 2084P0804X
MO20130293982084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200008604Medicaid
PA1969275OtherHIGHMARK- BLUE CROSS BLUE SHIELD
PA1019357820001Medicaid
11762810OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE