Healthcare Provider Details

I. General information

NPI: 1770977217
Provider Name (Legal Business Name): ALISSA CERNY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 GORDON DR
EXTON PA
19341
US

IV. Provider business mailing address

702 GORDON DR
EXTON PA
19341-1253
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-1330
  • Fax: 610-524-8574
Mailing address:
  • Phone: 610-363-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD464099
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: