Healthcare Provider Details

I. General information

NPI: 1770674723
Provider Name (Legal Business Name): GREGORY J ALLAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL DEPT OF NEUROLOGY
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL DEPT OF NEUROLOGY
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-8197
  • Fax: 781-624-4378
Mailing address:
  • Phone: 781-624-8197
  • Fax: 781-624-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number78812
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: