Provider Demographics
NPI:1407962905
Name:ELLIOTT, ALEXANDRA T (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:T
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:FEGAN 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6401
Mailing Address - Fax:617-730-0392
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FEGAN 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6401
Practice Address - Fax:617-730-0392
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA208629207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology