Provider Demographics
NPI:1699596007
Name:OLSON, ALEXANDER ROBERT
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ROBERT
Last Name:OLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:ROBERT
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DENNISON ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1315
Mailing Address - Country:US
Mailing Address - Phone:978-998-9916
Mailing Address - Fax:
Practice Address - Street 1:75 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2763
Practice Address - Country:US
Practice Address - Phone:978-212-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker