Healthcare Provider Details

I. General information

NPI: 1043560105
Provider Name (Legal Business Name): ALVINE DESAMOURS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 PARKWAY DR SUITE 500
HANOVER MD
21076-1388
US

IV. Provider business mailing address

7250 PARKWAY DR SUITE 500
HANOVER MD
21076-1388
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: