Basic Information
| Provider Information | |||||||||
| NPI: | 1225164635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LETOURNEAU | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MASSACHUSETTS GENERAL HOSPITAL | ||||||||
| Address2: | 55 FRUIT STREET | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262066 | ||||||||
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| Practice Location | |||||||||
| Address1: | MASSACHUSETTS GENERAL HOSPITAL | ||||||||
| Address2: | 55 FRUIT STREET | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 03/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 235266 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 235266 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207RI0200X | 235266 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.