Provider Demographics
NPI:1699959114
Name:GEORGIADIS, ALEXANDROS LAZAROS (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDROS
Middle Name:LAZAROS
Last Name:GEORGIADIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-586-0333
Mailing Address - Fax:
Practice Address - Street 1:1801 S 5TH ST STE 215
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2932
Practice Address - Country:US
Practice Address - Phone:956-630-7788
Practice Address - Fax:956-229-6180
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN97032084A2900X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2849937-09Medicaid