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Provider Information for 1992871412

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ALEX GERVACIO CUENCA MD

Gender: MALE

Individual NPI: 1992871412

Calendar   Last Updated:  2019-06-17
  Certification Date: 

Details

Name Value
NPI 1992871412
Enumeration Date 2006-11-27
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-6000 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-6000 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2086S0120X - Surgery Pediatric Surgery MA 270597
No 208600000X - Surgery MA 270597
No 208600000X - Surgery FL 511220