Provider Demographics
NPI:1497851158
Name:PINKERSON, ALEXANDRA IAN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:IAN
Last Name:PINKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LITTLE POND RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3552
Mailing Address - Country:US
Mailing Address - Phone:508-747-5135
Mailing Address - Fax:
Practice Address - Street 1:1147 HANCOCK ST
Practice Address - Street 2:STE 215-216
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4343
Practice Address - Country:US
Practice Address - Phone:617-328-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2062052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27059OtherBLUE CROSS BLUE SHIELD
MAH57788Medicare UPIN
MAA33730Medicare ID - Type Unspecified