Provider Demographics
NPI:1073503603
Name:KIMBALL, ALEXANDRA BOER (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:BOER
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:BOER
Other - Last Name:KIMBALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MPH
Mailing Address - Street 1:375 LONGWOOD AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5395
Mailing Address - Country:US
Mailing Address - Phone:617-632-7444
Mailing Address - Fax:617-726-7768
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-3753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222718207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469829OtherTUFTS HEALTH PLAN
MA2083850Medicaid
MAJ28105OtherBCBS MA
G67877Medicare UPIN
MA2083850Medicaid