Healthcare Provider Details

I. General information

NPI: 1053047704
Provider Name (Legal Business Name): MR. ALEXANDER PAVLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 HIGHPOINTE CIR
LANGHORNE PA
19047-5160
US

IV. Provider business mailing address

2093 PHILADELPHIA PIKE # 6014
CLAYMONT DE
19703-2424
US

V. Phone/Fax

Practice location:
  • Phone: 267-223-4353
  • Fax:
Mailing address:
  • Phone: 267-223-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW22847
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: