Provider Demographics
NPI:1497781470
Name:SIMONE, ALYSSA L (DO)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:L
Last Name:SIMONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:517-787-4146
Practice Address - Street 1:610 W GERMANTOWN PIKE STE 150
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1062
Practice Address - Country:US
Practice Address - Phone:610-525-4966
Practice Address - Fax:610-525-0874
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012434207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099298HYTMedicare PIN