Provider Demographics
NPI:1144768979
Name:JEAN BAPTISTE, ALEXANDRA (MD,PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:JEAN BAPTISTE
Suffix:
Gender:F
Credentials:MD,PA
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:SENAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:42 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5014
Mailing Address - Country:US
Mailing Address - Phone:781-605-3438
Mailing Address - Fax:781-605-3681
Practice Address - Street 1:42 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5014
Practice Address - Country:US
Practice Address - Phone:781-605-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA888-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042104356OtherJEWISH FAMILY & CHILDREN SERVICES