Provider Demographics
NPI:1396158606
Name:MCKENNA, ALYSSA (DO)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MCKENNA
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 1:1221 MERCANTILE LANE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:724-773-8900
Mailing Address - Fax:724-770-7947
Practice Address - Street 1:1221 MERCANTILE LANE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-386-6600
Practice Address - Fax:724-770-7947
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT015909207Q00000X
DCD0034658207Q00000X
MDH83105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine