Provider Demographics
NPI:1114380797
Name:MIESES MALCHUK, ALEXA MAUREEN (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:MAUREEN
Last Name:MIESES MALCHUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:MAUREEN
Other - Last Name:MIESES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:814-353-3519
Mailing Address - Fax:570-353-3500
Practice Address - Street 1:226 BUCKAROO LN
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9120
Practice Address - Country:US
Practice Address - Phone:814-353-3519
Practice Address - Fax:814-353-3500
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-01197207Q00000X
PAMD488453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine