Healthcare Provider Details

I. General information

NPI: 1720019524
Provider Name (Legal Business Name): SUSAN L ALEXANDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 HOME RD
DELAWARE OH
43015-8906
US

IV. Provider business mailing address

710 HOME RD
DELAWARE OH
43015-8906
US

V. Phone/Fax

Practice location:
  • Phone: 330-329-6414
  • Fax:
Mailing address:
  • Phone: 330-329-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-055243
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: