Basic Information
| Provider Information | |||||||||
| NPI: | 1902825862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLARD | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 WRIGHT ST | ||||||||
| Address2: | WING MEMORIAL HOSPITAL | ||||||||
| City: | PALMER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010641138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132837651 | ||||||||
| FaxNumber: | 4132845117 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 WRIGHT ST | ||||||||
| Address2: | WING MEMORIAL HOSPITAL | ||||||||
| City: | PALMER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010641138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132845241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 42902 | MA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 710690 | 01 | CONNECTICARE | OTHER | L15123 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 042902 | 01 | TUFTS COMMUNITY HEALTH PL | OTHER | 2069415 | 01 | NETWORK HEALTH | OTHER | 243418 | 01 | HARVARD PILGRIM | OTHER | 300127953 | 01 | RAILROAD MEDICARE | OTHER | 6639010009 | 01 | CIGNA | OTHER | 2069415 | 05 | MA | MEDICAID | 3547842 | 01 | HEALTHSOURCE CMHC | OTHER |