Provider Demographics
NPI:1992297337
Name:MARCONI, ALEXA (DO)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:MARCONI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CLUB LN STE 102
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-7957
Mailing Address - Country:US
Mailing Address - Phone:724-459-5203
Mailing Address - Fax:724-459-0949
Practice Address - Street 1:56 CLUB LN STE 102
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7957
Practice Address - Country:US
Practice Address - Phone:724-459-5203
Practice Address - Fax:724-459-0949
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018513207Q00000X
PAOS020998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine