Healthcare Provider Details

I. General information

NPI: 1598074544
Provider Name (Legal Business Name): ALEXANDER PHILIPOVSKIY M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 CURRENCY CIR
LAKE MARY FL
32746-2115
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 407-804-6133
  • Fax: 866-447-9143
Mailing address:
  • Phone: 407-804-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberR0932
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: