Provider Demographics
NPI:1265183552
Name:SUPRANOWICZ, ALLISON ROSE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:ROSE
Last Name:SUPRANOWICZ
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:43 STRONG AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7226
Mailing Address - Country:US
Mailing Address - Phone:413-442-8541
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST # 2622
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant