Provider Demographics
NPI:1083719835
Name:ALEXAKOS, MARK JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JASON
Last Name:ALEXAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CONSTITUTION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3127
Mailing Address - Country:US
Mailing Address - Phone:831-796-1704
Mailing Address - Fax:781-598-8137
Practice Address - Street 1:20 CENTRAL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1201
Practice Address - Country:US
Practice Address - Phone:781-596-2502
Practice Address - Fax:781-598-8137
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1522922084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59649Medicare UPIN
MA3165167Medicaid
G59649Medicare UPIN