Provider Demographics
NPI:1366889933
Name:LEDOUX, ALLISON M (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:LEDOUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LONGWATER RIVE
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-9147
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA255617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-2297845OtherMULTI-PLAN
042297845OtherTRICARE
042297845OtherUNITED HEALTH CARE
MA571665OtherTUFTS AND TMP
MAAA499832OtherHARVARD PILGRIM
MA110115835AMedicaid
1782498OtherCIGNA
MA1366889933OtherBCBSMA
MA1366889933OtherNHP
MA1366889933OtherFALLON HEALTH CARE
042297845OtherGIC
4194779OtherAETNA
MA110115835AMedicaid