Healthcare Provider Details

I. General information

NPI: 1295775385
Provider Name (Legal Business Name): ALEJANDRO PERALTA SOLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CRAWFORD ST STE 100
NEEDHAM MA
02494
US

IV. Provider business mailing address

15 CRAWFORD ST STE 100
NEEDHAM MA
02494-2618
US

V. Phone/Fax

Practice location:
  • Phone: 617-969-4100
  • Fax:
Mailing address:
  • Phone: 617-969-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number35087640
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number35087640
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: