Provider Demographics
NPI:1619428372
Name:POPPE, ALISON (PA-C)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:POPPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 FORT AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1432
Mailing Address - Country:US
Mailing Address - Phone:484-883-1357
Mailing Address - Fax:
Practice Address - Street 1:2 ADAMS PL
Practice Address - Street 2:SUITE 305
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7456
Practice Address - Country:US
Practice Address - Phone:617-302-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant