Provider Demographics
NPI:1083222186
Name:TONKONOGY, ALEX (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:TONKONOGY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BANCROFT PARK
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747-1810
Mailing Address - Country:US
Mailing Address - Phone:774-287-6862
Mailing Address - Fax:
Practice Address - Street 1:4 BANCROFT PARK
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1810
Practice Address - Country:US
Practice Address - Phone:774-287-6862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant