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NPI Code Detail

MEDICARE: MS. ALEXANDRA BLISS COLARUSSO PA-C

MEDICARE: MS. ALEXANDRA BLISS COLARUSSO PA-C
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
1363A00000XPhysician Assistant0010-09236NC

General Provider Information

NPI Number : 1952813354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALEXANDRA BLISS COLARUSSO PA-C
Provider Business Mailing Address
First Line : 11035 GOLF LINKS DR # 79217
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8045
Country : US
Telephone Number : 704-247-8355
Fax Number :
Provider Business Practice Location Address
First Line : 7940 WILLIAMS POND LN STE 150
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8409
Country : US
Telephone Number : 704-247-8355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2017
Last Update Date : 01/28/2021

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