Provider Demographics
NPI:1770977217
Name:CERNY, ALISSA (MD)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:CERNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1253
Mailing Address - Country:US
Mailing Address - Phone:610-363-1330
Mailing Address - Fax:
Practice Address - Street 1:702 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-363-1330
Practice Address - Fax:610-524-8574
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464099208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program