MEDICARE: ALEXANDRA LEE GENTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA8668	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447919444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA LEE GENTRY

Provider Business Mailing Address
First Line	:	960 MASSACHUSETTS AVE
Second Line	:	FL 2
City	:	BOSTON
State	:	MA
Zip	:	02118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	736 CAMBRIDGE ST
Second Line	:	7TH, FL
City	:	BRIGHTON
State	:	MA
Zip	:	02135
Country	:	US
Telephone Number	:	617-562-7026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2021
Last Update Date	:	06/08/2026

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Directions to “ ALEXANDRA LEE GENTRY ” Practice Location

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