Healthcare Provider Details

I. General information

NPI: 1285339119
Provider Name (Legal Business Name): ALEXANDROV MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CEDAR RIDGE LN
MANSFIELD MA
02048-3284
US

IV. Provider business mailing address

5 CEDAR RIDGE LN
MANSFIELD MA
02048-3284
US

V. Phone/Fax

Practice location:
  • Phone: 973-978-9037
  • Fax:
Mailing address:
  • Phone: 973-978-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL ALEXANDROV
Title or Position: OWNER
Credential: MD
Phone: 973-978-9037