Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 77492 | MA |
N | 2080P0202X | Pediatric Cardiologist | 77492 | MA |
NPI | 1013907666 |
---|---|
Provider Name | Mark Edward Alexander |
First Address | Brookline, MA 02446-9135 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 18/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3183467 | (05) | MA |
G73623 | (02) |