Provider Demographics
NPI:1053574160
Name:ALEXANDER, CRAIG HOLT (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:HOLT
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S. 4TH STREET #201
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2091
Mailing Address - Country:US
Mailing Address - Phone:502-584-3200
Mailing Address - Fax:502-584-3333
Practice Address - Street 1:305 S. 4TH STREET #201
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:502-584-3200
Practice Address - Fax:502-584-3333
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY484522080P0202X, 207RA0002X
KYTP6012080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Yes207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100362960Medicaid
OH0141248Medicaid
IN201320800Medicaid
KYK161350Medicare PIN