Healthcare Provider Details

I. General information

NPI: 1013334317
Provider Name (Legal Business Name): ALEXANDRA HATHAWAY BAKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAIN 1 - EMERGENCY 300 LONGWOOD AVE
BOSTON MA
02115
US

IV. Provider business mailing address

MAIN 1 - EMERGENCY 300 LONGWOOD AVE
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6624
  • Fax:
Mailing address:
  • Phone: 617-355-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number269819
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: