MEDICARE: ALEXANIAN MEDICAL CONSULTING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1033853221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANIAN MEDICAL CONSULTING INC

Provider Business Mailing Address
First Line	:	30461 PASSAGEWAY PL
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30461 PASSAGEWAY PL
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2030
Country	:	US
Telephone Number	:	424-262-0474
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SERGE ALEXANIAN
Credential	:	MD
Telephone Number	:	424-262-0474

Provider Enumeration Date	:	04/24/2022
Last Update Date	:	04/24/2022

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