Basic Information
Provider Information | |||||||||
NPI: | 1376801274 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALEXANDER | ||||||||
FirstName: | COLLEEN | ||||||||
MiddleName: | MCINTYRE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCINTYRE | ||||||||
OtherFirstName: | COLLEEN | ||||||||
OtherMiddleName: | MICHELLE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 700 ACKERMAN RD STE 570 | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432021579 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6142933230 | ||||||||
FaxNumber: | 6142934030 | ||||||||
Practice Location | |||||||||
Address1: | 1800 ZOLLINGER RD FL 3 | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 43221 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6142933230 | ||||||||
FaxNumber: | 6142934030 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/27/2012 | ||||||||
LastUpdateDate: | 08/07/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35130060 | OH | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 0229917 | 05 | OH |   | MEDICAID |