Healthcare Provider Details

I. General information

NPI: 1326050147
Provider Name (Legal Business Name): ROSALINDA SISON-ALIDIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 YORK RD
BALTIMORE MD
21212-3001
US

IV. Provider business mailing address

6010 YORK RD
BALTIMORE MD
21212-3001
US

V. Phone/Fax

Practice location:
  • Phone: 410-435-4308
  • Fax: 410-323-6353
Mailing address:
  • Phone: 410-435-4308
  • Fax: 410-323-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0014988
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: