Individual
MRS. ALEXANDRA KATHRYN GROUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
177 FORT WASHINGTON AVE, MHB RM 8-004, NEW YORK, NY 10032-3733
(212) 342-0432
Mailing address
1175 EASTERN AVE, CHARLTON, NY 12019-2911
(518) 495-8031
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
015827
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104201
NCCPA CERTIFICATION
—
Enumeration date
09/18/2012
Last updated
09/13/2024
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