MEDICARE: AMARIN ALEXANDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME83127	FL
2	208M00000X	Hospitalist Physician	ME83127	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00212207	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C539	OTHER	FL	HEALTH FIRST NETWORK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	82138	OTHER	FL	BLUE CROSS BLUE SHIELD
6	59177878	OTHER	AL	BLUE CROSS BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215926373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARIN ALEXANDER MD

Provider Business Mailing Address
First Line	:	4801 SOLITARY DR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-6554
Country	:	US
Telephone Number	:	321-434-4600
Fax Number	:	321-434-4662

Provider Business Practice Location Address
First Line	:	1350 S HICKORY ST
Second Line	:	HOLMES REGIONAL MEDICAL CENTER
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3224
Country	:	US
Telephone Number	:	321-434-1771
Fax Number	:	321-434-1774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	10/06/2017

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Directions to “ AMARIN ALEXANDER MD” Practice Location

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