Healthcare Provider Details

I. General information

NPI: 1275375909
Provider Name (Legal Business Name): ALEXANDER MATTHEW CONJELKO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 NAJOLES RD STE 300
MILLERSVILLE MD
21108-2670
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 443-351-3376
  • Fax: 443-494-2303
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200001966
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009497
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: