Provider Demographics
NPI:1871987818
Name:DIESEL, ALISON L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:L
Last Name:DIESEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:M
Other - Last Name:LATHROUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10324 OLD OCEAN CITY BLVD.
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811
Mailing Address - Country:US
Mailing Address - Phone:410-629-0041
Mailing Address - Fax:410-629-0544
Practice Address - Street 1:10324 OLD OCEAN CITY BLVD.
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-629-0041
Practice Address - Fax:410-629-0544
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05717363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC05717OtherMD MEDICAL LICENSE