Healthcare Provider Details

I. General information

NPI: 1215793096
Provider Name (Legal Business Name): ALEXANDER JAMES NARDONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE
JBPHH HI
96860-4908
US

IV. Provider business mailing address

III MARINE EXPEDITIONARY FORCE SURGEON UNIT 35605
FPO AP
96382
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-3285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101286695
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: