Provider Demographics
NPI:1619242310
Name:PASTORINO, ALYSSA R (DO)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:PASTORINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:R
Other - Last Name:MORELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5131 BEACON HILL RD
Mailing Address - Street 2:STE #220
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-4442
Mailing Address - Country:US
Mailing Address - Phone:614-544-1880
Mailing Address - Fax:
Practice Address - Street 1:5131 BEACON HILL RD
Practice Address - Street 2:STE #220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4442
Practice Address - Country:US
Practice Address - Phone:614-544-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012022208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126642Medicaid