Provider Demographics
NPI:1336428440
Name:PARK, ALYSSA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MARIE
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8242
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-8200
Mailing Address - Fax:314-367-5016
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1032
Practice Address - Country:US
Practice Address - Phone:570-271-6328
Practice Address - Fax:570-271-6955
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2020-06-09
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Provider Licenses
StateLicense IDTaxonomies
PAMD457758208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology