Healthcare Provider Details

I. General information

NPI: 1255578332
Provider Name (Legal Business Name): ALEXANDRA HOVAGUIMIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE SHAPIRO TCC8
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE SHAPIRO TCC8
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-2268
  • Fax: 617-667-2987
Mailing address:
  • Phone: 617-667-2268
  • Fax: 617-667-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number240463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: