Provider Demographics
NPI:1700869443
Name:ALEXANDER COLE, CORINNE
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:
Last Name:ALEXANDER COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CORINNE
Other - Middle Name:
Other - Last Name:ALEXANDER COLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:FOUNDERS 600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:614-724-9197
Mailing Address - Fax:617-724-8693
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:FOUNDERS 600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:614-724-9197
Practice Address - Fax:617-724-8693
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2275950207R00000X
MA227950207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110073514Medicaid
MA110073514Medicaid