MEDICARE: DR. ALEXSANDRA M MAMONIS 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	207Q00000X	Family Medicine Physician	35070377	OH
2	207R00000X	Internal Medicine Physician	35070377	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447213889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXSANDRA M MAMONIS MD

Provider Business Mailing Address
First Line	:	1700 BOETTLER RD STE 125
Second Line	:
City	:	UNIONTOWN
State	:	OH
Zip	:	44685-6207
Country	:	US
Telephone Number	:	330-896-9099
Fax Number	:	330-896-9199

Provider Business Practice Location Address
First Line	:	1700 BOETTLER RD
Second Line	:	SUITE 125
City	:	UNIONTOWN
State	:	OH
Zip	:	44685-6207
Country	:	US
Telephone Number	:	330-896-9099
Fax Number	:	330-896-9199

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	12/05/2025

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