Healthcare Provider Details

I. General information

NPI: 1356760821
Provider Name (Legal Business Name): AMANDA E MACONE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA E L'BASSI

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY STREET SHAPIRO 7, SUITE B
BOSTON MA
02118
US

IV. Provider business mailing address

801 ALBANY ST FL GROUND
BOSTON MA
02119-2560
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8456
  • Fax: 617-638-8465
Mailing address:
  • Phone: 617-414-6035
  • Fax: 617-414-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18741
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: