Provider Demographics
NPI:1023079167
Name:HSIEH, ALICE S (DO)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:S
Last Name:HSIEH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 OLD COURT RD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5103
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:1000 E JOPPA RD
Practice Address - Street 2:SUITE 313
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5622
Practice Address - Country:US
Practice Address - Phone:410-825-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH43974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCN6601OtherR/R MEDICARE GROUP #
MDF92008Medicare UPIN
MD266L219LMedicare PIN
MDCN6601OtherR/R MEDICARE GROUP #