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General NPI Number Information
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NPI Number | 1912840497
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Entity Type | Individual
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Provider Name | ALEXANDRA CATHERINE PUYANA THEALL MD, MHPE
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Gender | Female
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 330 BROOKLINE AVE
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City | BOSTON
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State | MA
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Zip | 02215-5491
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Country | US
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Telephone | 617-610-5193
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Fax |
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Provider Business Mailing Address
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Address Line | 55 COLELLA RD UNIT 1
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City | NEWTON
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State | MA
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Zip | 02459-3623
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 3020855
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License Number State | MA
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