Healthcare Provider Details

I. General information

NPI: 1689315913
Provider Name (Legal Business Name): ALANNA DOMINIQUE MEADOWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST
BOSTON MA
02114-3117
US

IV. Provider business mailing address

50 STANIFORD ST FL 4
BOSTON MA
02114-2517
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number1028390
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1028390
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1028390
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: