Healthcare Provider Details

I. General information

NPI: 1295268076
Provider Name (Legal Business Name): ALYNA M DALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W SQUANTUM ST
NORTH QUINCY MA
02171-2122
US

IV. Provider business mailing address

110 W SQUANTUM ST
NORTH QUINCY MA
02171-2122
US

V. Phone/Fax

Practice location:
  • Phone: 617-376-3000
  • Fax: 617-774-1905
Mailing address:
  • Phone: 617-376-3000
  • Fax: 617-774-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5891
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: