Healthcare Provider Details

I. General information

NPI: 1225492945
Provider Name (Legal Business Name): ALEKSANDRA SARAH DAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC HEMATOLOGY/ONCOLOGY
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC HEMATOLOGY/ONCOLOGY
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1190
  • Fax:
Mailing address:
  • Phone: 215-590-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMT219855
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: