Healthcare Provider Details

I. General information

NPI: 1013548262
Provider Name (Legal Business Name): DALLY ALEX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DALLY ALEX CRNP

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

14022 JUMP DR
GERMANTOWN MD
20874-6122
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-2475
  • Fax:
Mailing address:
  • Phone: 484-674-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR208579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: