Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 35132487 | OH |
N | 2080P0208X | Pediatric Infectious Diseases | 35132487 | OH |
NPI | 1356735518 |
---|---|
Provider Name | Dr. Alexandra Medoro |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 07/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0438168 | (05) | OH |