Healthcare Provider Details

I. General information

NPI: 1629866199
Provider Name (Legal Business Name): ALEXANDRA MARIA PENTIKIS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 W WASHINGTON ST # 403
HAGERSTOWN MD
21740-4884
US

IV. Provider business mailing address

32 W WASHINGTON ST # 403
HAGERSTOWN MD
21740-4884
US

V. Phone/Fax

Practice location:
  • Phone: 240-527-2752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200002589
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: