MEDICARE: MARCUS ALEXANDER

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1750072005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS ALEXANDER

Provider Business Mailing Address
First Line	:	22 CULVER LN FL 1
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3727
Country	:	US
Telephone Number	:	475-355-3871
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 CULVER LN FL 1
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3727
Country	:	US
Telephone Number	:	475-355-3871
Fax Number	:

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

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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Directions to “ MARCUS ALEXANDER ” Practice Location

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