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General NPI Number Information
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NPI Number | 1023632247
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Entity Type | Individual
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Provider Name | XANTHIA ALIX TUCKER MD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 801 MASSACHUSETTS AVE SUITE 5A, CROSSTOWN BLDG
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City | BOSTON
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State | MA
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Zip | 02118
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Country | US
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Telephone | 617-414-5951
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Fax | 617-414-9201
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE STE 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 1019694
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1019694
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License Number State | MA
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