Healthcare Provider Details

I. General information

NPI: 1659369551
Provider Name (Legal Business Name): ALISA A. LOSASSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISA ALFONSI

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT STREET EAST SUITE 300
PHILADELPHIA PA
19107-4405
US

IV. Provider business mailing address

P.O. BOX 191
ROCKLAND DE
19723-0191
US

V. Phone/Fax

Practice location:
  • Phone: 215-861-8830
  • Fax: 215-861-8833
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD074378L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD074378L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: