Provider Demographics
NPI:1528172426
Name:ORLIKOV, ALEX B (MD, PHD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:B
Last Name:ORLIKOV
Suffix:
Gender:M
Credentials:MD, PHD
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Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-243-6524
Mailing Address - Fax:617-243-6486
Practice Address - Street 1:2014 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-243-6524
Practice Address - Fax:617-243-6486
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2028052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H50964Medicare UPIN