Provider Demographics
NPI:1114607280
Name:PREM, ALLISON MAUREEN
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MAUREEN
Last Name:PREM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 CANDLE LIGHT RUN
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9592
Mailing Address - Country:US
Mailing Address - Phone:585-944-0136
Mailing Address - Fax:
Practice Address - Street 1:6314 CANDLE LIGHT RUN
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9592
Practice Address - Country:US
Practice Address - Phone:585-944-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant