Provider Demographics
NPI:1881814796
Name:ACKELSON, ALISSA V (MD)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:V
Last Name:ACKELSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:135 N EWING ST
Practice Address - Street 2:SUITE 303
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3382
Practice Address - Country:US
Practice Address - Phone:740-687-8805
Practice Address - Fax:740-687-8803
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2016-09-29
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Provider Licenses
StateLicense IDTaxonomies
OH35083382207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2493823Medicaid
OHH099521Medicare PIN