Healthcare Provider Details

I. General information

NPI: 1194789826
Provider Name (Legal Business Name): ALEC E DANZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 WORCESTER ST
WELLESLEY MA
02481-5420
US

IV. Provider business mailing address

230 WORCESTER STREET ADULT URGENT CARE
WELLESLEY MA
02481-5491
US

V. Phone/Fax

Practice location:
  • Phone: 781-431-5200
  • Fax: 781-431-5298
Mailing address:
  • Phone: 781-431-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: