Provider Demographics
NPI:1821592007
Name:GEANACOPOULOS, ALEXANDRA TESS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:TESS
Last Name:GEANACOPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:BCH3066
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6624
Mailing Address - Fax:617-730-0355
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:HUNNEWELL BUILDING, PAVILION 129, HOUSESTAFF LOUNGE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA286905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics