Healthcare Provider Details

I. General information

NPI: 1073503603
Provider Name (Legal Business Name): ALEXANDRA BOER KIMBALL MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA BOER KIMBALL MD MPH

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215
US

IV. Provider business mailing address

375 LONGWOOD AVE STE 3
BOSTON MA
02215-5395
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3753
  • Fax:
Mailing address:
  • Phone: 617-632-7444
  • Fax: 617-726-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number222718
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: