Basic Information
| Provider Information | |||||||||
| NPI: | 1740219195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACCARDI | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | LUZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1261 FURNACE BROOK PKWY | ||||||||
| Address2: | SUITE 31 | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174794545 | ||||||||
| FaxNumber: | 6174794555 | ||||||||
| Practice Location | |||||||||
| Address1: | 1261 FURNACE BROOK PKWY | ||||||||
| Address2: | SUITE 31 | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174794545 | ||||||||
| FaxNumber: | 6174794555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 59573 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 3079457 | 05 | MA | MEDICAID | S027977 | 01 | MA | CHAMPUS | OTHER | J08248 | 01 | MA | BLUECROSS/BLUESHIELD | OTHER |