Provider Demographics
NPI:1942301239
Name:ALLIED PEDIATRICS OF GREATER BROCKTON INC.
Entity Type:Organization
Organization Name:ALLIED PEDIATRICS OF GREATER BROCKTON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-427-7700
Mailing Address - Street 1:179 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2966
Mailing Address - Country:US
Mailing Address - Phone:508-427-7700
Mailing Address - Fax:
Practice Address - Street 1:179 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2966
Practice Address - Country:US
Practice Address - Phone:508-427-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9780122Medicaid
MAM16595OtherBLUE CROSS GROUP NUMBER