Healthcare Provider Details

I. General information

NPI: 1861223364
Provider Name (Legal Business Name): ALYSSA N BIALEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

10913 GREAT OAK WAY
COLUMBIA MD
21044-3783
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-2475
  • Fax:
Mailing address:
  • Phone: 443-285-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0009469
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: