MEDICARE: DR. ALISA A. LOSASSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD074378L	PA
2	208000000X	Pediatrics Physician	MD074378L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659369551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISA A. LOSASSO MD

Provider Business Mailing Address
First Line	:	P.O. BOX 191
Second Line	:
City	:	ROCKLAND
State	:	DE
Zip	:	19723-0191
Country	:	US
Telephone Number	:	302-651-6212
Fax Number	:	302-651-4945

Provider Business Practice Location Address
First Line	:	833 CHESTNUT STREET EAST
Second Line	:	SUITE 300
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4405
Country	:	US
Telephone Number	:	215-861-8830
Fax Number	:	215-861-8833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	09/02/2011

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Directions to “ DR. ALISA A. LOSASSO MD” Practice Location

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