Provider Demographics
NPI:1558333468
Name:ALLEY, CONSUELA R (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSUELA
Middle Name:R
Last Name:ALLEY
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 1:9 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45167-1229
Mailing Address - Country:US
Mailing Address - Phone:937-392-0005
Mailing Address - Fax:937-392-6067
Practice Address - Street 1:9 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-1229
Practice Address - Country:US
Practice Address - Phone:937-392-0005
Practice Address - Fax:937-392-6067
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2182589Medicaid
G56717Medicare UPIN
OHAL 4022911Medicare ID - Type Unspecified