Individual
IAN ALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-4618
Mailing address
1 BOSTON WAY UNIT 107, NEWBURYPORT, MA 01950-4181
(617) 304-5894
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2457
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2457
LICENSE NUMBER
ME
01
—
PA9034
LICESNSE NUMBER
MA
Enumeration date
09/21/2022
Last updated
01/18/2023
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