MEDICARE: DR. MARK PETER ALEXANDER M.D., MBA

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	04-26767	KS
2	207R00000X	Internal Medicine Physician	112522	MO
3	207R00000X	Internal Medicine Physician	25MA08323800	NJ

General Provider Information

NPI Number	:	1316097223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK PETER ALEXANDER M.D., MBA

Provider Business Mailing Address
First Line	:	5301 WELLINGTON AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1449
Country	:	US
Telephone Number	:	609-823-0555
Fax Number	:	609-823-0330

Provider Business Practice Location Address
First Line	:	5301 WELLINGTON AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1449
Country	:	US
Telephone Number	:	609-823-0555
Fax Number	:	609-823-0330

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	05/10/2017

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