Provider Demographics
NPI:1407299951
Name:ANASTASOPULOS, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:ANASTASOPULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 PHILLIPS STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3459
Mailing Address - Country:US
Mailing Address - Phone:310-254-5931
Mailing Address - Fax:
Practice Address - Street 1:85 PHILLIPS ST
Practice Address - Street 2:#7
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3459
Practice Address - Country:US
Practice Address - Phone:123-456-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program