Healthcare Provider Details

I. General information

NPI: 1831944701
Provider Name (Legal Business Name): ALYSSA MULLERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14302 BARTON BLVD SW
CUMBERLAND MD
21502-5852
US

IV. Provider business mailing address

14302 BARTON BLVD SW
CUMBERLAND MD
21502-5852
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-3278
  • Fax:
Mailing address:
  • Phone: 301-729-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010013
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: