Prom De Illanes, Maria C

Prom De Illanes, Maria C is an individual health care provider with primary practice located at 1 Boston Medical Ctr Pl , Boston MA 02118-2908. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychosomatic Medicine, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Psychosomatic Medicine is her primary health care specialty. Prom De Illanes, Maria C can be contacted via phone (617) 414-5245.

Contact Information

Primary practice address
1 Boston Medical Ctr Pl Boston MA 02118-2908
Phone: (617) 414-5245
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychosomatic Medicine 2084P0015X 269371 Massachusetts
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 269371 Massachusetts

Profile Details

NPI number 1710390851
LBN Legal business name Prom De Illanes, Maria C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2014
Last updated Dec 18th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710390851 NPPES
Massachusetts MEDICAID 110106417A

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