Healthcare Provider Details

I. General information

NPI: 1053818120
Provider Name (Legal Business Name): ALYSSA C CORTESE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2025-01865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: