Basic Information
| Provider Information | |||||||||
| NPI: | 1366889933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDOUX | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER RIVE | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020619147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2013 | ||||||||
| LastUpdateDate: | 01/20/2017 | ||||||||
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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 | 207Q00000X | 255617 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04-2297845 | 01 | MULTI-PLAN | OTHER | 042297845 | 01 | TRICARE | OTHER | 042297845 | 01 | UNITED HEALTH CARE | OTHER | 571665 | 01 | MA | TUFTS AND TMP | OTHER | AA499832 | 01 | MA | HARVARD PILGRIM | OTHER | 110115835A | 05 | MA | MEDICAID | 1782498 | 01 | CIGNA | OTHER | 1366889933 | 01 | MA | BCBSMA | OTHER | 1366889933 | 01 | MA | NHP | OTHER | 1366889933 | 01 | MA | FALLON HEALTH CARE | OTHER | 042297845 | 01 | GIC | OTHER | 4194779 | 01 | AETNA | OTHER |