Healthcare Provider Details

I. General information

NPI: 1962623009
Provider Name (Legal Business Name): ALEX MEPARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZURAB MEPHARISHVILI M.D.

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

720 LISA CIR
HUNTINGDON VALLEY PA
19006-2223
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2844
  • Fax: 215-214-1425
Mailing address:
  • Phone: 610-217-0017
  • Fax: 267-722-8467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-436836
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: