Provider Demographics
NPI:1043265713
Name:VANEK, ALEXANDRA CARLEO (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:CARLEO
Last Name:VANEK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-1593
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 ROCK MERRITT AVE
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-1593
Practice Address - Country:US
Practice Address - Phone:910-907-7000
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-01507207P00000X
SC25402207P00000X
TN45762207P00000X
FL114826207P00000X
CA144431207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10058585OtherAMERIGROUP
GA649853088BMedicaid
GA649853088CMedicaid
SC649853088FMedicaid
GA649853088AMedicaid
GA649853088DMedicaid
TN1518018Medicaid
SCG57760Medicaid
GA649853088BMedicaid
GA649853088CMedicaid
I51365Medicare UPIN
GA649853088DMedicaid
SC649853088FMedicaid
GAP00338109Medicare PIN