Provider Demographics
NPI:1023000866
Name:WON, ALISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:
Last Name:WON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 RITCHIE HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2741
Mailing Address - Country:US
Mailing Address - Phone:410-789-7337
Mailing Address - Fax:410-349-1107
Practice Address - Street 1:1460 RITCHIE HWY STE 209
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2741
Practice Address - Country:US
Practice Address - Phone:410-789-7337
Practice Address - Fax:410-789-0425
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062438208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7256396OtherAETNA FEE FOR SERVICE
MD4224238OtherCIGNA PIN
MD64356802OtherBCBS
MD3769080OtherAETNA CAPITATED
DC38940011OtherBCBS
MD406584100Medicaid
MD7605-0068OtherCAREFIRST BLUECHOICE
MD64356803OtherBCBS
MD8565391OtherAETNA HMO
MD8130796OtherMAMSI PRIMARY CARE
MDP16585OtherCAREFIRST MPOS
MD108885OtherJHHC PROVIDER NUMBER
MD2130796OtherMAMSI SPECIALTY
MD643568-01OtherCAREFIRST MD RENDERING
MDP20252OtherBCBS
MD406584100Medicaid
MD108885OtherJHHC PROVIDER NUMBER