Provider Demographics
NPI:1346297298
Name:MODENA, ALISA BENSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:BENSON
Last Name:MODENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1502 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3504
Mailing Address - Country:US
Mailing Address - Phone:856-429-3149
Mailing Address - Fax:
Practice Address - Street 1:101 CARNIE BLVD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1548
Practice Address - Country:US
Practice Address - Phone:856-325-3328
Practice Address - Fax:856-325-3276
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08055000207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine