Provider Demographics
NPI:1689930075
Name:CONDE GREEN, ALEXANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:CONDE GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 GLADES RD STE 302
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4372
Mailing Address - Country:US
Mailing Address - Phone:561-617-0240
Mailing Address - Fax:
Practice Address - Street 1:6100 GLADES RD STE 302
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4372
Practice Address - Country:US
Practice Address - Phone:561-617-0240
Practice Address - Fax:561-763-9353
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137217208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery