Healthcare Provider Details

I. General information

NPI: 1386638807
Provider Name (Legal Business Name): EDWARD LEE ALEXANDER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 11/01/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 S NEW ST
DOVER DE
19904-3540
US

IV. Provider business mailing address

640 S. STATE ST. MAIL CODE 3055
DOVER DE
19904-4158
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4070
  • Fax: 302-672-2315
Mailing address:
  • Phone: 302-674-4070
  • Fax: 302-672-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC10002593
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: