Healthcare Provider Details

I. General information

NPI: 1659207645
Provider Name (Legal Business Name): ALEX KHRISTENKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 TRAVANCORE CT
RANDALLSTOWN MD
21133-1315
US

IV. Provider business mailing address

4305 TRAVANCORE CT
RANDALLSTOWN MD
21133-1315
US

V. Phone/Fax

Practice location:
  • Phone: 443-986-2294
  • Fax:
Mailing address:
  • Phone: 443-986-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR242126
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: