Provider Demographics
NPI:1629146782
Name:ASHENBERG, ALENA (MD)
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:ASHENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 NASHUA RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1929
Mailing Address - Country:US
Mailing Address - Phone:978-957-4300
Mailing Address - Fax:978-957-3891
Practice Address - Street 1:505 NASHUA RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-1929
Practice Address - Country:US
Practice Address - Phone:978-957-4300
Practice Address - Fax:978-957-3891
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77683208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9740261Medicaid
MA97873202OtherNETWORK HEALTH
MAJ 14292OtherBCBS MA INDIVIDUAL #
MA077683OtherTUFTS PROVIDER NUMBER
MAJ 14292OtherBCBS MA INDIVIDUAL #