Healthcare Provider Details

I. General information

NPI: 1174087167
Provider Name (Legal Business Name): ALEXANDRA GUERRIERE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA ADOLPH-GOTHIER PA

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 09/05/2020
Certification Date: 09/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

16 E BISHOPS RD
BALTIMORE MD
21218-2312
US

V. Phone/Fax

Practice location:
  • Phone: 855-217-9614
  • Fax:
Mailing address:
  • Phone: 717-497-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0007073
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: