Healthcare Provider Details

I. General information

NPI: 1518336346
Provider Name (Legal Business Name): ALEXIA PROULX P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 DARTMOUTH ST STE 603
BOSTON MA
02116-5883
US

IV. Provider business mailing address

860 MAIN RD
CORFU NY
14036-9753
US

V. Phone/Fax

Practice location:
  • Phone: 617-903-5000
  • Fax: 415-252-7176
Mailing address:
  • Phone: 585-599-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA7461
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number019066
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: