Provider Demographics
NPI:1184122905
Name:AVILLACH, CLAIRE (MD)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:
Last Name:AVILLACH
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 1:650 ALBANY ST RM 540
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2518
Mailing Address - Country:US
Mailing Address - Phone:617-638-7330
Mailing Address - Fax:617-638-7326
Practice Address - Street 1:650 ALBANY ST RM 540
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2518
Practice Address - Country:US
Practice Address - Phone:617-638-7330
Practice Address - Fax:617-638-7326
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1013556207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology