Provider Demographics
NPI:1770674723
Name:ALLAM, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:ALLAM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL DEPT OF NEUROLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:781-624-8197
Mailing Address - Fax:781-624-4378
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL DEPT OF NEUROLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:781-624-8197
Practice Address - Fax:781-624-4378
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-09-04
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Provider Licenses
StateLicense IDTaxonomies
MA788122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3157504Medicaid
MAA22079Medicare PIN
MA130014372Medicare PIN
MA3157504Medicaid