Provider Demographics
NPI:1629557764
Name:HUOTH, ALLISON PHALLIME
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:PHALLIME
Last Name:HUOTH
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 1:10 LAWNDALE RD
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1520
Mailing Address - Country:US
Mailing Address - Phone:978-761-4008
Mailing Address - Fax:
Practice Address - Street 1:10 LAWNDALE RD
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1520
Practice Address - Country:US
Practice Address - Phone:978-761-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant