Provider Demographics
NPI:1225477318
Name:DR ALEXANDER C. NNABUE AND ASSOCIATES,PA
Entity type:Organization
Organization Name:DR ALEXANDER C. NNABUE AND ASSOCIATES,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-231-4086
Mailing Address - Street 1:10240 LAKE ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3113
Mailing Address - Country:US
Mailing Address - Phone:301-324-9500
Mailing Address - Fax:301-324-9502
Practice Address - Street 1:10240 LAKE ARBOR WAY
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-3113
Practice Address - Country:US
Practice Address - Phone:301-324-9500
Practice Address - Fax:301-324-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD69074150Medicaid
MD69074150Medicaid