Provider Demographics
NPI:1104152297
Name:LAVIGNE, ALISON (MD,)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 418837
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8837
Mailing Address - Country:US
Mailing Address - Phone:607-324-2340
Mailing Address - Fax:607-324-7615
Practice Address - Street 1:4901 TELSA DR
Practice Address - Street 2:SUITE A & B
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4406
Practice Address - Country:US
Practice Address - Phone:301-805-6860
Practice Address - Fax:301-805-0755
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD454142085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology