Healthcare Provider Details

I. General information

NPI: 1710201694
Provider Name (Legal Business Name): ALON GEVA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2010
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVENUE, BOSTON CHILDREN'S HOSPITAL DIVISION OF CRITICAL CARE MEDICINE, BADER 634
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7327
  • Fax: 617-730-0453
Mailing address:
  • Phone: 617-355-7327
  • Fax: 617-730-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number254480
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: