Healthcare Provider Details

I. General information

NPI: 1619348505
Provider Name (Legal Business Name): ALISON CLAIRE D'ANDELET DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2015
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 S MAIN ST
BEL AIR MD
21014
US

IV. Provider business mailing address

437 S MAIN ST
BEL AIR MD
21014-3919
US

V. Phone/Fax

Practice location:
  • Phone: 410-836-0131
  • Fax: 410-836-8594
Mailing address:
  • Phone: 410-836-0131
  • Fax: 410-836-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP98718
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01633
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: