Provider Demographics
NPI:1083671465
Name:SMITH, ALLEN L (MD MS)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:BRIGHAM PRIMARY PHYSICIANS AT FAULKNER HOSPITAL
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3450
Mailing Address - Country:US
Mailing Address - Phone:617-983-7699
Mailing Address - Fax:
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:BRIGHAM PRIMARY PHYSICIANS AT FAULKNER HOSPITAL
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3450
Practice Address - Country:US
Practice Address - Phone:617-983-7699
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA59397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine