Provider Demographics
NPI:1194179713
Name:ALEXANDER, ANASTASIA (PA)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 INTERLAKEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01266-9600
Mailing Address - Country:US
Mailing Address - Phone:978-424-6656
Mailing Address - Fax:
Practice Address - Street 1:68 INTERLAKEN RD
Practice Address - Street 2:
Practice Address - City:WEST STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01266-9600
Practice Address - Country:US
Practice Address - Phone:978-424-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5702363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical