Provider Demographics
NPI:1881404044
Name:ALAGON, ALYSSA RAE
Entity type:Individual
Prefix:
First Name:ALYSSA RAE
Middle Name:
Last Name:ALAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8812 GERST AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9631
Mailing Address - Country:US
Mailing Address - Phone:443-850-5621
Mailing Address - Fax:
Practice Address - Street 1:5445 LOCH RAVEN BLVD STE 403A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2943
Practice Address - Country:US
Practice Address - Phone:443-850-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program