Provider Demographics
NPI:1871745125
Name:VAN ALPHEN, MANJOLA (MD, PHD, MBA)
Entity type:Individual
Prefix:DR
First Name:MANJOLA
Middle Name:
Last Name:VAN ALPHEN
Suffix:
Gender:F
Credentials:MD, PHD, MBA
Other - Prefix:DR
Other - First Name:MANJOLA
Other - Middle Name:
Other - Last Name:UJKAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD, MBA
Mailing Address - Street 1:301 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2807
Practice Address - Country:US
Practice Address - Phone:617-912-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2373002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry