Provider Demographics
NPI:1679937999
Name:CHANTARA, ALEXANDRA DEE MAXTED (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:DEE MAXTED
Last Name:CHANTARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:DEE
Other - Last Name:MAXTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1455 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6727
Mailing Address - Country:US
Mailing Address - Phone:901-726-6655
Mailing Address - Fax:901-726-9056
Practice Address - Street 1:1455 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6727
Practice Address - Country:US
Practice Address - Phone:901-726-6655
Practice Address - Fax:901-726-9056
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61380207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology