Basic Information
| Provider Information | |||||||||
| NPI: | 1104958073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENNIG | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 PARKER HILL AVE | ||||||||
| Address2: | NE BAPTIST HOSPITAL ORTHOPEDICS | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021202847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177546743 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 MAPLE ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | GILFORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032495510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035226163 | ||||||||
| FaxNumber: | 6035243153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 230931 | MA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.