Provider Demographics
NPI:1740966829
Name:BALTAZAR, ALEXANDRA XANTHOULA (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:XANTHOULA
Last Name:BALTAZAR
Suffix:
Gender:F
Credentials:PA-C
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Other - Last Name:
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Mailing Address - Street 1:308 WOODLAND CIR
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1679
Mailing Address - Country:US
Mailing Address - Phone:413-426-3111
Mailing Address - Fax:
Practice Address - Street 1:308 WOODLAND CIR
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1679
Practice Address - Country:US
Practice Address - Phone:413-426-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant