Individual
MISS ALLICIA GAIL ELIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1651
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2913813
VA PROVIDER NUMBER
MA
01
—
ME0623024J
MASS CONTROLLED SUBSTANCE
MA
Enumeration date
08/25/2006
Last updated
03/07/2023
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