Provider Demographics
NPI:1134651433
Name:TARABOCHIA-GAST, ALEXANDRA T (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:T
Last Name:TARABOCHIA-GAST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:T
Other - Last Name:GAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1983 SLOAN PL STE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2095
Mailing Address - Country:US
Mailing Address - Phone:651-326-7500
Mailing Address - Fax:
Practice Address - Street 1:1983 SLOAN PL STE 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2095
Practice Address - Country:US
Practice Address - Phone:651-326-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73947207Q00000X
MA282532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3125582Medicaid
MA110127140AMedicaid