Provider Demographics
NPI:1215926373
Name:ALEXANDER, AMARIN (MD)
Entity type:Individual
Prefix:
First Name:AMARIN
Middle Name:
Last Name:ALEXANDER
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 1:4801 SOLITARY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6554
Mailing Address - Country:US
Mailing Address - Phone:321-434-4600
Mailing Address - Fax:321-434-4662
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:HOLMES REGIONAL MEDICAL CENTER
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-1771
Practice Address - Fax:321-434-1774
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83127207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00212207OtherMEDICARE RAILROAD
AL009989865Medicaid
FLC539OtherHEALTH FIRST NETWORK
FL268563900Medicaid
FL82138OtherBLUE CROSS BLUE SHIELD
AL59177878OtherBLUE CROSS BLUE SHIELD
AL59177878OtherBLUE CROSS BLUE SHIELD
P00212207OtherMEDICARE RAILROAD