Provider Demographics
NPI:1477848034
Name:CROSSAN, ALESSA SOOK (MD)
Entity type:Individual
Prefix:
First Name:ALESSA
Middle Name:SOOK
Last Name:CROSSAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N HILL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2677
Mailing Address - Country:US
Mailing Address - Phone:540-349-1882
Mailing Address - Fax:703-738-7157
Practice Address - Street 1:45 N HILL DR STE 202
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2677
Practice Address - Country:US
Practice Address - Phone:540-349-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63863207W00000X
DCMD045246207WX0107X
VA0101262608207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30016106580001Medicaid
WI1477848034Medicaid