Provider Demographics
NPI:1518205921
Name:ISOM, ALICIA RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:RENEE
Last Name:ISOM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5574
Mailing Address - Country:US
Mailing Address - Phone:301-393-2600
Mailing Address - Fax:301-393-2614
Practice Address - Street 1:1161 OMEGA DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5574
Practice Address - Country:US
Practice Address - Phone:301-393-2600
Practice Address - Fax:301-393-2614
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH79818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics