Provider Demographics
NPI:1003092081
Name:ALLEYNE, KHALIL (MD)
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:
Last Name:ALLEYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-6750
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-6750
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261206207Q00000X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-2297845OtherGIC-UNICARE
04-2297845OtherHCVM-FIRST HEALTH
042297845OtherTRICARE
MA5322676OtherCIGNA
04-2297845OtherMULTI-PLAN
MA042297845OtherMULTI-PLAN
MA859751OtherTUFTS AND TMP
MA1003092081OtherNEIGHBORHOOD HEALTH PLAN
MA1003092081OtherBCBSMA
04-2297845OtherTRICARE
MA1003092081OtherFALLON
MA042297845OtherHCVM
MAAA384133OtherHARVARD PILGRIM
MA110100673AMedicaid