Provider Demographics
NPI:1184744948
Name:OVERSTREET, ANNALISA DEBACCO (MD)
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:DEBACCO
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 MEDICAL PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3282
Mailing Address - Country:US
Mailing Address - Phone:410-266-3900
Mailing Address - Fax:410-266-9245
Practice Address - Street 1:2002 MEDICAL PKWY STE 230
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3282
Practice Address - Country:US
Practice Address - Phone:410-266-3900
Practice Address - Fax:410-266-9245
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073946207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD241791ZASAMedicare PIN