Provider Demographics
NPI:1205811718
Name:KAZURA, ALESSANDRA NINA (MD)
Entity type:Individual
Prefix:DR
First Name:ALESSANDRA
Middle Name:NINA
Last Name:KAZURA
Suffix:
Gender:F
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 40
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0040
Mailing Address - Country:US
Mailing Address - Phone:508-909-7799
Mailing Address - Fax:508-764-2432
Practice Address - Street 1:336 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1587
Practice Address - Country:US
Practice Address - Phone:508-765-9167
Practice Address - Fax:508-764-2462
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA755362084P0804X
RIMD077082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7005970Medicaid
RI7005970Medicaid
F21287Medicare UPIN