Provider Demographics
NPI:1780817189
Name:LAMOUREUX, ALISSA T (DO)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:T
Last Name:LAMOUREUX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2932
Mailing Address - Country:US
Mailing Address - Phone:506-644-0505
Mailing Address - Fax:
Practice Address - Street 1:555 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545
Practice Address - Country:US
Practice Address - Phone:508-644-0505
Practice Address - Fax:508-644-0506
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11187207N00000X
NH17371207N00000X
MA265177207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology