Provider Demographics
NPI:1750489522
Name:AUGUST, ALLISON MARLENE (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARLENE
Last Name:AUGUST
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 1:195 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5568
Mailing Address - Country:US
Mailing Address - Phone:781-263-0033
Mailing Address - Fax:781-263-0098
Practice Address - Street 1:195 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5568
Practice Address - Country:US
Practice Address - Phone:781-263-0033
Practice Address - Fax:781-263-0098
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist