Provider Demographics
NPI:1477584753
Name:WELLS, ALYSON DELANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:DELANE
Last Name:WELLS
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 1:10151 YORK ROAD
Mailing Address - Street 2:SUITES 112-114
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3398
Mailing Address - Country:US
Mailing Address - Phone:410-628-8200
Mailing Address - Fax:410-628-8203
Practice Address - Street 1:10151 YORK RD
Practice Address - Street 2:SUITES 112-114
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-3314
Practice Address - Country:US
Practice Address - Phone:410-628-8200
Practice Address - Fax:410-628-8203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00528922086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH98212Medicare UPIN
MD181PMedicare ID - Type UnspecifiedGROUP
MD181P419GMedicare ID - Type UnspecifiedRENDERING