Provider Demographics
NPI:1205333127
Name:KROKHMAL, ALEKSANDRA AUGUSTYNOWICZ (MD)
Entity type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:AUGUSTYNOWICZ
Last Name:KROKHMAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEKSANDRA
Other - Middle Name:
Other - Last Name:AUGUSTYNOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:65 LEWIS ST APT 616
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-3378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:224-766-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2807212085N0904X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty