Provider Demographics
NPI:1508757287
Name:PETKEWICH, ALEXA NICOLA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:NICOLA
Last Name:PETKEWICH
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WALDEN POND AVE
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-1145
Mailing Address - Country:US
Mailing Address - Phone:781-854-6680
Mailing Address - Fax:
Practice Address - Street 1:53 WALDEN POND AVE
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-1145
Practice Address - Country:US
Practice Address - Phone:781-854-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant