Provider Demographics
NPI:1174335921
Name:PRESTEL, ALEXANDRA VAUGHAN (CNM)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:VAUGHAN
Last Name:PRESTEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:VAUGHAN
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5605 EVERHURST RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4303
Mailing Address - Country:US
Mailing Address - Phone:301-704-3026
Mailing Address - Fax:
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR245574176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty