Provider Demographics
NPI:1861526915
Name:ALEXANDROV, ANDREI V (MD)
Entity type:Individual
Prefix:
First Name:ANDREI
Middle Name:V
Last Name:ALEXANDROV
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 1:855 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4901
Mailing Address - Country:US
Mailing Address - Phone:901-448-6199
Mailing Address - Fax:
Practice Address - Street 1:855 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4901
Practice Address - Country:US
Practice Address - Phone:901-448-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000050775174400000X
TN507752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942587Medicaid
MS04686751Medicaid
AL051540496OtherBLUE CROSS
AL051540494OtherBLUE CROSS
TNQ003328Medicaid
AL009942586Medicaid
AR202109001Medicaid