Basic Information
Provider Information
NPI: 1386141687
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLAIS
FirstName: BLAIR
MiddleName: SAUNDERS
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 75 FRANCIS ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021156106
CountryCode: US
TelephoneNumber: 6177324918
FaxNumber:  
Practice Location
Address1: 75 FRANCIS ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021156110
CountryCode: US
TelephoneNumber: 8572728354
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/12/2018
LastUpdateDate: 08/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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