Provider Demographics
NPI:1447484779
Name:VANALLEN, ELIEZER MENDEL (MD)
Entity type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:MENDEL
Last Name:VANALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 BROOKLINE AVE # D1230
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-6656
Mailing Address - Fax:617-632-6656
Practice Address - Street 1:450 BROOKLINE AVE # D1230
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-6656
Practice Address - Fax:617-632-6656
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107423207R00000X
MA243362207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine