Healthcare Provider Details

I. General information

NPI: 1619409257
Provider Name (Legal Business Name): JONATHAN STRUAN ALEXANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SABIN ST MSC 635
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

39 SABIN ST MSC 635
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-4271
  • Fax:
Mailing address:
  • Phone: 843-792-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number83736
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: