Provider Demographics
NPI:1568464279
Name:ALEXEYENKO, ALEXANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:ALEXEYENKO
Suffix:
Gender:M
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-0086
Mailing Address - Country:US
Mailing Address - Phone:781-749-9071
Mailing Address - Fax:781-749-2133
Practice Address - Street 1:24 STATE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1505
Practice Address - Country:US
Practice Address - Phone:781-581-6181
Practice Address - Fax:781-599-3229
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3113485Medicaid
MAF66615Medicare UPIN
MA3113485Medicaid