Healthcare Provider Details

I. General information

NPI: 1245479336
Provider Name (Legal Business Name): DR. ALEXANDER C NNABUE AND ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 WOODYARD RD
CLINTON MD
20735-4203
US

IV. Provider business mailing address

10240 LAKE ARBOR WAY
MITCHELLVILLE MD
20721-3113
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-1770
  • Fax: 301-877-3207
Mailing address:
  • Phone: 301-324-9500
  • Fax: 301-324-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA1277
License Number StateMD

VIII. Authorized Official

Name: DR. PATRICIA PARKS
Title or Position: BILLING MANAGER
Credential:
Phone: 517-231-4086