Provider Demographics
NPI:1013233352
Name:DANIEL, ALYSSA SEARLES (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SEARLES
Last Name:DANIEL
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-9700
Mailing Address - Fax:980-302-9730
Practice Address - Street 1:6324 FAIRVIEW RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3361
Practice Address - Country:US
Practice Address - Phone:980-302-9700
Practice Address - Fax:980-302-9730
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC165244207R00000X
NC2014-00838207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013233352Medicaid
SCNC2200Medicaid
SCNC2200Medicaid