Healthcare Provider Details

I. General information

NPI: 1750383337
Provider Name (Legal Business Name): ALEXANDER D MINARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST STE 306
MARIETTA OH
45750-1656
US

IV. Provider business mailing address

PO BOX 449
MARIETTA OH
45750-0449
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-5044
  • Fax: 740-374-1792
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35080109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: