Provider Demographics
NPI:1992133102
Name:IDENBURG, ALEXANDRA MARIA ELIZABETH (MD, MRCGP(UK))
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MARIA ELIZABETH
Last Name:IDENBURG
Suffix:
Gender:F
Credentials:MD, MRCGP(UK)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-4364
Mailing Address - Country:US
Mailing Address - Phone:207-487-7292
Mailing Address - Fax:207-487-7156
Practice Address - Street 1:105 MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-4364
Practice Address - Country:US
Practice Address - Phone:207-487-7292
Practice Address - Fax:207-487-7156
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-25
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19326208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1558862508OtherHEALTH PLANS INC
ME1558862508OtherHUMANA
ME1992133102OtherHARVARD PILGRIM
ME1992133102OtherHUMANA
ME1558862508OtherUNITED HEALTH CARE
ME1558862508Medicaid
ME1992133102OtherWELLCARE
ME1992133102OtherCIGNA
ME1558862508OtherHARVARD PILGRIM
ME1558862508OtherCIGNA
ME1992133102OtherUNITED HEALTH CARE
ME1992133102OtherAETNA & AETNA/US HEALTHCARE
ME1992133102OtherUSFHP
ME1558862508OtherAETNA & AETNA/US HEALTHCARE
ME1558862508OtherWELLCARE
ME1558862508OtherBCBS
ME1558862508OtherUSFHP
ME1992133102OtherHEALTH PLANS INC
ME1992133102Medicaid
ME1992133102OtherBCBS