Provider Demographics
NPI:1568849123
Name:CONDE, ALISSA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:CONDE
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 1:9560 CHILDREN'S DRIVE
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-636-6800
Mailing Address - Fax:513-636-6835
Practice Address - Street 1:9560 CHILDREN'S DRIVE
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-636-6800
Practice Address - Fax:513-636-6835
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1338912080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine