Provider Demographics
NPI:1215096243
Name:ALEXANDER, ALISON (MD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
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:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9022
Mailing Address - Fax:215-226-8286
Practice Address - Street 1:MAINLINE MEDICAL GROUP
Practice Address - Street 2:857 MONTGOMERY AVENUE
Practice Address - City:NARBETH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-664-2951
Practice Address - Fax:610-664-2131
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056081-L207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1957179OtherHBS
PA2836592000OtherIBC/KHPE/PC
PA1855795OtherCIGNA PIN
PA2053189OtherUNITED HEALTHCARE
PA597586OtherMEDICARE GROUP
PAP00721294OtherRR MEDICARE
PA5552322OtherAETNA PIN
PA102117408Medicaid
PA3Y6260OtherHEALTH NET
PA5552322OtherAETNA PIN