Healthcare Provider Details

I. General information

NPI: 1225477318
Provider Name (Legal Business Name): DR ALEXANDER C. NNABUE AND ASSOCIATES,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 LAKE ARBOR WAY
MITCHELLVILLE MD
20721-3113
US

IV. Provider business mailing address

10240 LAKE ARBOR WAY
MITCHELLVILLE MD
20721-3113
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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