Provider Demographics
NPI:1194194951
Name:RALLIS, TENA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:TENA
Middle Name:MARIA
Last Name:RALLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 ESSEX CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2902
Mailing Address - Country:US
Mailing Address - Phone:978-977-4110
Mailing Address - Fax:978-977-4149
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-977-4110
Practice Address - Fax:978-977-4149
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2021-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA265089207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400281897Medicare PIN