Basic Information
| Provider Information | |||||||||
| NPI: | 1316991003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BATCHEV | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 791 | ||||||||
| Address2: | |||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600650791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475938460 | ||||||||
| FaxNumber: | 2242354652 | ||||||||
| Practice Location | |||||||||
| Address1: | 2057 W 8TH ST | ||||||||
| Address2: | #1 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145200411 | ||||||||
| FaxNumber: | 2242354652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OS014963 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207Q00000X | OS14963 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34.009399 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000904683 | 01 | PA | HIGMARK | OTHER | 001672150 | 05 | PA | MEDICAID |