Healthcare Provider Details

I. General information

NPI: 1396370342
Provider Name (Legal Business Name): ALEXANDRA ELDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 OFFICENTER PL
GAHANNA OH
43230-5317
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-1707
  • Fax: 614-293-1716
Mailing address:
  • Phone: 614-293-1707
  • Fax: 614-293-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number35.155315
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.155315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: