Provider Demographics
NPI:1003881624
Name:CAMPAGNA, ALLYSON (PA)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:CAMPAGNA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:FOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 PARKER HILL AVENUE
Mailing Address - Street 2:ORTHO 4TH FLOOR MAIN BLDG
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120
Mailing Address - Country:US
Mailing Address - Phone:617-754-5800
Mailing Address - Fax:617-754-6443
Practice Address - Street 1:125 PARKER HILL AVENUE
Practice Address - Street 2:ORTHO 4TH FLOOR MAIN BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:617-754-5800
Practice Address - Fax:617-754-6443
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2021363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ57360Medicare UPIN
MAAP2532Medicare ID - Type Unspecified