Individual
ALEXANDER THOMAS AVERSANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6701 N CHARLES ST, TOWSON, MD 21204-6881
(443) 849-8046
(443) 849-8057
Mailing address
6565 N CHARLES ST STE 203, TOWSON, MD 21204-5805
(443) 849-3760
(443) 849-8138
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H0093511
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390200000X
PROVIDER
—
05
—
390200000X
—
MD
Enumeration date
04/26/2017
Last updated
06/29/2023
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