Basic Information
Provider Information
NPI: 1508875501
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIGALOVSKY
FirstName: ALEX
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 64795
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212644795
CountryCode: US
TelephoneNumber: 4103286704
FaxNumber: 4103284124
Practice Location
Address1: 22 S GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011544
CountryCode: US
TelephoneNumber: 4103286704
FaxNumber: 4103284124
Other Information
ProviderEnumerationDate: 08/07/2006
LastUpdateDate: 05/30/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XR147700MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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