Provider Demographics
NPI:1043256860
Name:LANDES, ALLISON H (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:H
Last Name:LANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1208
Practice Address - Country:US
Practice Address - Phone:207-781-1775
Practice Address - Fax:207-781-1780
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014773208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME331770099Medicaid