Healthcare Provider Details

I. General information

NPI: 1003443433
Provider Name (Legal Business Name): ALEXANDER JAMES JAKSIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

4 EMERSON PL APT 504
BOSTON MA
02114-2278
US

V. Phone/Fax

Practice location:
  • Phone: 781-223-0948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5331
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberD0103248
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: