Provider Demographics
NPI:1558856245
Name:FOGARTY, ALEXANDRA ELISABETH COLLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ELISABETH COLLEEN
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 PARKMAN ST # 340
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3117
Mailing Address - Country:US
Mailing Address - Phone:314-726-8810
Mailing Address - Fax:617-726-3441
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:314-726-8810
Practice Address - Fax:617-726-3441
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018014951208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation