Provider Demographics
NPI:1285295964
Name:ALSTON, DEIDRA (PA-C)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:ALSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 AIRY HILL CT UNIT E
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2724
Mailing Address - Country:US
Mailing Address - Phone:419-306-6824
Mailing Address - Fax:
Practice Address - Street 1:1607 AIRY HILL CT UNIT E
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2724
Practice Address - Country:US
Practice Address - Phone:419-306-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant