Healthcare Provider Details

I. General information

NPI: 1215342779
Provider Name (Legal Business Name): ALEXANDRIA MARIE UKLEJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRIA UKLEJA KADOLPH MD

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOSES CONE HOSPITAL 1121 N CHURCH ST
GREENSBORO NC
27405
US

IV. Provider business mailing address

400 SHELTON ST
GREENSBORO NC
27405-5655
US

V. Phone/Fax

Practice location:
  • Phone: 336-951-4641
  • Fax:
Mailing address:
  • Phone: 203-809-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number216979
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017-01659
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: