Provider Demographics
NPI:1427266261
Name:LARBALESTRIER, ALISA MAE (MD)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:MAE
Last Name:LARBALESTRIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 HOSPITAL DRIVE, EMERGENCY DEPARTMENT
Mailing Address - Street 2:BALTIMORE WASHINGTON MEDICAL CENTER
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-787-4349
Mailing Address - Fax:410-328-8028
Practice Address - Street 1:301 HOSPITAL DRIVE, EMERGENCY DEPARTMENT
Practice Address - Street 2:BALTIMORE WASHINGTON MEDICAL CENTER
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-787-4349
Practice Address - Fax:410-328-8028
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0069981207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program