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NPI Code Detail

MEDICARE: ALEXANDRA R PORTUGUES MS

MEDICARE: ALEXANDRA R PORTUGUES MS
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1396310785
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA R PORTUGUES MS
Provider Business Mailing Address
First Line : 2900 W QUEEN LN
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1033
Country : US
Telephone Number : 215-991-8202
Fax Number :
Provider Business Practice Location Address
First Line : 2900 W QUEEN LN
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1033
Country : US
Telephone Number : 215-991-8202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2021
Last Update Date : 05/26/2021

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1871241851 — NICOLE MAURER
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Directions to “ ALEXANDRA R PORTUGUES MS” Practice Location

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