Healthcare Provider Details

I. General information

NPI: 1780616227
Provider Name (Legal Business Name): ALEXY J KOCHOWIEC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LYNN COMM. HEALTH CENTER 269 UNION ST.
LYNN MA
01901
US

IV. Provider business mailing address

269 UNION STREET LYNN COMMUNITY HEALTH INC.
LYNN MA
01901-1314
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-3900
  • Fax:
Mailing address:
  • Phone: 781-581-3900
  • Fax: 781-598-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number209813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: