Healthcare Provider Details

I. General information

NPI: 1902825862
Provider Name (Legal Business Name): JEFFREY C ALLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WRIGHT ST WING MEMORIAL HOSPITAL
PALMER MA
01064-1138
US

IV. Provider business mailing address

40 WRIGHT ST WING MEMORIAL HOSPITAL
PALMER MA
01064-1138
US

V. Phone/Fax

Practice location:
  • Phone: 413-284-5241
  • Fax:
Mailing address:
  • Phone: 413-283-7651
  • Fax: 413-284-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number42902
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: