Basic Information
| Provider Information | |||||||||
| NPI: | 1265687230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCOLLUM | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 HENRY ST | ||||||||
| Address2: | ST 1G | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112012526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188584924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 506 6TH STREET | ||||||||
| Address2: | RM 506 DEPT. OF PEDIATRICS, NYM | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187805260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2008 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2530631 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.