Healthcare Provider Details

I. General information

NPI: 1538288162
Provider Name (Legal Business Name): ALYSON BETH SIMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 02/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 CLUB HOUSE RD
GLADWYNE PA
19035-1004
US

IV. Provider business mailing address

704 S BROAD ST
LANSDALE PA
19446-5242
US

V. Phone/Fax

Practice location:
  • Phone: 267-416-0212
  • Fax:
Mailing address:
  • Phone: 267-416-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08244000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080I0007X
TaxonomyPediatric Clinical & Laboratory Immunology Physician
License NumberMD430551
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD430551
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD430551
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberMD430551
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD430551
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: