Provider Demographics
NPI:1982640405
Name:LAESER, ALYSSA B (PA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:B
Last Name:LAESER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PICCARD DR
Mailing Address - Street 2:STE 202
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4303
Mailing Address - Country:US
Mailing Address - Phone:301-921-7900
Mailing Address - Fax:301-921-7915
Practice Address - Street 1:44330 MERCURE CIR STE 240E
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2024
Practice Address - Country:US
Practice Address - Phone:703-727-0523
Practice Address - Fax:703-935-0330
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12196770OtherCAQH
VA006548E14Medicare ID - Type Unspecified