Provider Demographics
NPI:1902287337
Name:GOLOVLEV, ALEXANDER VALERIKOVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:VALERIKOVICH
Last Name:GOLOVLEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2072 CHILHOWEE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 CANNON ST
Practice Address - Street 2:#503
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-7901
Practice Address - Country:US
Practice Address - Phone:843-792-9457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.38416.LL207L00000X
GA83405207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology