Provider Demographics
NPI:1548629942
Name:CARTER, ALEXANDER J (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:J
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 CHAGRIN BLVD STE 244
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5525
Mailing Address - Country:US
Mailing Address - Phone:844-746-8537
Mailing Address - Fax:216-450-1810
Practice Address - Street 1:25501 CHAGRIN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5603
Practice Address - Country:US
Practice Address - Phone:844-746-8537
Practice Address - Fax:216-450-1810
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004597RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157912Medicaid
OHH393112OtherMEDICARE
OHH393111OtherMEDICARE