Provider Demographics
NPI:1467910695
Name:MA, ALICE (MBBS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF RADIOLOGY
Mailing Address - Street 2:820 HARRISON AVE FGH BUILDING 4TH FL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5135
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF RADIOLOGY
Practice Address - Street 2:820 HARRISON AVE FGH BUILDING 4TH FL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-10-25
Deactivation Date:2019-10-16
Deactivation Code:
Reactivation Date:2019-10-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program