Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 80537 | MA |
Y | 2080P0205X | Pediatric Endocrinologist | 80537 | MA |
NPI | 1225129471 |
---|---|
Provider Name | Holley Fales Allen |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 29/12/2017 |