Provider Demographics
NPI:1962081380
Name:PECORARO, ALEXANDRIA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:ANNE
Last Name:PECORARO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:ANNE
Other - Last Name:CUMMUTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1083 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4033
Mailing Address - Country:US
Mailing Address - Phone:224-456-8746
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 1106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3845
Practice Address - Country:US
Practice Address - Phone:312-942-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-04
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361708562084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program