Provider Demographics
NPI:1629562368
Name:MANCINI, ALYSSA JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:JOAN
Last Name:MANCINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:BUL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-228-4315
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BUL 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-0287
Practice Address - Fax:617-228-4315
Is Sole Proprietor?:No
Enumeration Date:2018-06-17
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA286411208M00000X, 207R00000X
MA276092390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program