Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 281649 | MA |
NPI | 1124431853 |
---|---|
Provider Name | Alanna Wong |
First Address | Boston, MA 02114-2335 |
Second Address | Boston, MA 02114-2335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 25/10/2021 |