Provider Demographics
NPI:1104089085
Name:TZAVARAS, ALEXANDER GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:GEORGE
Last Name:TZAVARAS
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 1:15 BERKELEY PL
Mailing Address - Street 2:APARTMENT 4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-4491
Mailing Address - Country:US
Mailing Address - Phone:646-271-8003
Mailing Address - Fax:
Practice Address - Street 1:2532 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4902
Practice Address - Country:US
Practice Address - Phone:718-960-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248887-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics