Provider Demographics
NPI:1588779839
Name:ALONSO, MIRIAM NOEMI (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:NOEMI
Last Name:ALONSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:NOEMI
Other - Last Name:ALONSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6301 CANDLEWICKE CT
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8115
Mailing Address - Country:US
Mailing Address - Phone:410-795-8628
Mailing Address - Fax:410-795-8628
Practice Address - Street 1:55 WADE AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4663
Practice Address - Country:US
Practice Address - Phone:410-402-6000
Practice Address - Fax:410-402-7997
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001912363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical