Healthcare Provider Details

I. General information

NPI: 1528556446
Provider Name (Legal Business Name): ALEX COLBATH BENDER MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

423 SOUTH ST
CARLISLE MA
01741-1517
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3311
  • Fax: 617-726-9250
Mailing address:
  • Phone: 856-906-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number64456
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number291136
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: