Healthcare Provider Details

I. General information

NPI: 1376736397
Provider Name (Legal Business Name): ALLISON MARIE AIKEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-1814
US

IV. Provider business mailing address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-6621
  • Fax: 510-642-1801
Mailing address:
  • Phone: 510-642-6621
  • Fax: 510-642-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC136557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: