Basic Information
| Provider Information | |||||||||
| NPI: | 1912998501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALFRED | ||||||||
| FirstName: | PIERRE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 184 MARKET DR | ||||||||
| Address2: | |||||||||
| City: | ATHOL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013319829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789393128 | ||||||||
| FaxNumber: | 9786502090 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 MARKET DR | ||||||||
| Address2: | |||||||||
| City: | ATHOL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013319829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789393128 | ||||||||
| FaxNumber: | 9786502090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 155979 | MA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | BA3518911 | 01 | DEA FEDERAL | OTHER | 3173046 | 05 | MA | MEDICAID | MA0318750AR | 01 | MA | DEA STATE | OTHER |