Provider Demographics
NPI:1083721781
Name:AVRAM, ALISON RANDI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:RANDI
Last Name:AVRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:SHARPE AVRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4 LONGFELLOW PLACE
Mailing Address - Street 2:#1611
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-670-1773
Mailing Address - Fax:617-670-1847
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-726-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMD-210420207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH23715Medicare UPIN