Healthcare Provider Details

I. General information

NPI: 1568045797
Provider Name (Legal Business Name): ALEXANDRA LAUREN MYERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 DELAWARE AVE
FOUNTAIN HILL PA
18015-1165
US

IV. Provider business mailing address

685 DELAWARE AVE
FOUNTAIN HILL PA
18015-1165
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-3890
  • Fax: 866-829-9836
Mailing address:
  • Phone: 484-526-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT222634
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMT222634
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: