Provider Demographics
NPI:1427150424
Name:ALEXANDER-MARTIN, ANGELICE L (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELICE
Middle Name:L
Last Name:ALEXANDER-MARTIN
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 1:2975 DONNYLANE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-3228
Mailing Address - Country:US
Mailing Address - Phone:614-442-2600
Mailing Address - Fax:614-442-1600
Practice Address - Street 1:2975 DONNYLANE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-3228
Practice Address - Country:US
Practice Address - Phone:614-442-2600
Practice Address - Fax:614-442-1600
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-080261207Q00000X, 2083A0300X
OH35080261207QA0401X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH032021509-00OtherBWC
OH7355546OtherAETNA
OH106506OtherNATIONWIDE HEALTH PLANS
OH000000295047OtherANTHEM BLUE CROSS BLUE SH
OH01-11291OtherUNITED HEALTHCARE
OH2364801Medicaid
OH350809868001OtherMEDICAL MUTUAL
OH7355546OtherAETNA
OH01-11291OtherUNITED HEALTHCARE