Provider Demographics
NPI:1679552582
Name:KELLEY-HEDGEPETH, ALYSON LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:LEE
Last Name:KELLEY-HEDGEPETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:110 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5521
Mailing Address - Country:US
Mailing Address - Phone:508-894-0400
Mailing Address - Fax:508-894-0459
Practice Address - Street 1:830 BOYLSTON ST STE 205
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2502
Practice Address - Country:US
Practice Address - Phone:617-732-1618
Practice Address - Fax:177-345-7636
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224099207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine