Provider Demographics
NPI:1629638077
Name:BALTHROP, ALISA
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:BALTHROP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W FRANKLIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2117
Mailing Address - Country:US
Mailing Address - Phone:443-925-2337
Mailing Address - Fax:
Practice Address - Street 1:400 W FRANKLIN ST STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2117
Practice Address - Country:US
Practice Address - Phone:443-925-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator