Healthcare Provider Details

I. General information

NPI: 1588385280
Provider Name (Legal Business Name): ALEXANDRA ECONOMOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 OSLER DR STE 200
TOWSON MD
21204-7701
US

IV. Provider business mailing address

7600 OSLER DR STE 200
TOWSON MD
21204-7701
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-8452
  • Fax: 410-828-5217
Mailing address:
  • Phone: 410-321-8425
  • Fax: 410-828-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: