MEDICARE: ALEXANDRA MARIE DORNER

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1366133415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA MARIE DORNER

Provider Business Mailing Address
First Line	:	2506 CRANBROOK LN APT 8
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-2000
Country	:	US
Telephone Number	:	484-619-6872
Fax Number	:

Provider Business Practice Location Address
First Line	:	2506 CRANBROOK LN APT 8
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-2000
Country	:	US
Telephone Number	:	484-619-6872
Fax Number	:

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

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	06/05/2023

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Directions to “ ALEXANDRA MARIE DORNER ” Practice Location

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