Healthcare Provider Details

I. General information

NPI: 1235607193
Provider Name (Legal Business Name): ALISON JEANNE MAILLOUX RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKET ST UNIT 1B
PORTSMOUTH NH
03801-3456
US

IV. Provider business mailing address

123 STATE ST
PORTSMOUTH NH
03801-3825
US

V. Phone/Fax

Practice location:
  • Phone: 603-294-4526
  • Fax: 603-590-2662
Mailing address:
  • Phone: 603-502-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1240
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: