1518963552 NPI number — DR. ANNE ELIZABETH ALLAN MD

Table of content: DR. ANNE ELIZABETH ALLAN MD (NPI 1518963552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518963552 NPI number — DR. ANNE ELIZABETH ALLAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLAN
Provider First Name:
ANNE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518963552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE CRANBERRY HILL, SUITE 303
Provider Second Line Business Mailing Address:
STRATA DIAGNOSTICS
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-252-6880
Provider Business Mailing Address Fax Number:
617-252-6563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02139-4853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-225-2526
Provider Business Practice Location Address Fax Number:
617-252-6563
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  52383 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3095410 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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