Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 252232 | MA |
NPI | 1053666164 |
---|---|
Provider Name | Alexandra Christodoulou |
First Address | Roslindale, MA 02131-1011 |
Second Address | Roslindale, MA 02131-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 16/07/2012 |