Healthcare Provider Details

I. General information

NPI: 1356728414
Provider Name (Legal Business Name): ALISHA DENISE WARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA DENISE GORDY

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE STREET
BALTIMORE MD
21264-4220
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number2022-01402
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD88677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: