Provider Demographics
NPI:1245240068
Name:COMERFORD, ALICE M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:COMERFORD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-754-5246
Mailing Address - Fax:617-754-6344
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-754-5246
Practice Address - Fax:617-754-6344
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37309363LF0000X
MA234418363LF0000X
MARN234418207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057832Medicaid
RI29923OtherBC/BS
RIQ24362Medicare UPIN
RI007057832Medicare ID - Type Unspecified