Healthcare Provider Details

I. General information

NPI: 1952964124
Provider Name (Legal Business Name): ALEXANDRA PIETRASZKIEWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 12/13/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10405 CENTRUM PKWY
PINEVILLE NC
28134-8825
US

IV. Provider business mailing address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

V. Phone/Fax

Practice location:
  • Phone: 704-295-3650
  • Fax:
Mailing address:
  • Phone: 704-838-8493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number13255686-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2023-02890
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: