Provider Demographics
NPI:1932343944
Name:WASSON, ALLISON LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:WASSON
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 1:130 FISHER RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8132
Mailing Address - Country:US
Mailing Address - Phone:802-371-4100
Mailing Address - Fax:716-298-5896
Practice Address - Street 1:246 GRANGER RD STE 2
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05641-5352
Practice Address - Country:US
Practice Address - Phone:802-225-5810
Practice Address - Fax:802-371-4821
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.0133794207Q00000X
WI56329-021207Q00000X
NY269075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1032312Medicaid
NY03809285Medicaid