Healthcare Provider Details

I. General information

NPI: 1427150424
Provider Name (Legal Business Name): ANGELICE L. ALEXANDER-MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 DONNYLANE BLVD
COLUMBUS OH
43235-3228
US

IV. Provider business mailing address

2975 DONNYLANE BLVD
COLUMBUS OH
43235-3228
US

V. Phone/Fax

Practice location:
  • Phone: 614-442-2600
  • Fax: 614-442-1600
Mailing address:
  • Phone: 614-442-2600
  • Fax: 614-442-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-080261
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35080261
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number35080261
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number35-080261
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: