Provider Demographics
NPI:1053517623
Name:SMITH-DEMAIN, ALEXANDRA KONETSKY (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:KONETSKY
Last Name:SMITH-DEMAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:KONETSKY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:708 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1205
Mailing Address - Country:US
Mailing Address - Phone:412-841-8853
Mailing Address - Fax:
Practice Address - Street 1:708 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-1205
Practice Address - Country:US
Practice Address - Phone:412-841-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 439846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine