Provider Demographics
NPI:1881684314
Name:ANTOON, ALIA YOUSIF (MD)
Entity Type:Individual
Prefix:DR
First Name:ALIA
Middle Name:YOUSIF
Last Name:ANTOON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:51 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2601
Practice Address - Country:US
Practice Address - Phone:617-371-4720
Practice Address - Fax:617-371-4825
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA345122080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM08305OtherBCBS MA
MA2002213Medicaid
MA724777OtherTUFTS HEALTH PLAN
MA2002213Medicaid
MA724777OtherTUFTS HEALTH PLAN