Healthcare Provider Details

I. General information

NPI: 1215988225
Provider Name (Legal Business Name): ALEXIS MORVANT KLOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 CHIEF JUSTICE CUSHING HWY STE 301
COHASSET MA
02025-1391
US

IV. Provider business mailing address

PO BOX 68
S WEYMOUTH MA
02190-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-383-6261
  • Fax: 781-383-1084
Mailing address:
  • Phone: 780-803-2786
  • Fax: 781-812-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209164
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: