Healthcare Provider Details

I. General information

NPI: 1104152297
Provider Name (Legal Business Name): ALISON LAVIGNE M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 TELSA DR SUITE A & B
BOWIE MD
20715-4406
US

IV. Provider business mailing address

PO BOX 418837
BOSTON MA
02241-8837
US

V. Phone/Fax

Practice location:
  • Phone: 301-805-6860
  • Fax: 301-805-0755
Mailing address:
  • Phone: 607-324-2340
  • Fax: 607-324-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD45414
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: