Provider Demographics
NPI:1104109305
Name:DE LARA, KRISTOFFER RYAN ALPAS (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTOFFER RYAN
Middle Name:ALPAS
Last Name:DE LARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTOFFER
Other - Middle Name:RYAN ALPAS
Other - Last Name:DE LARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-528-2810
Mailing Address - Fax:301-528-2811
Practice Address - Street 1:19735 GERMANTOWN RD
Practice Address - Street 2:SUITE 360
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1214
Practice Address - Country:US
Practice Address - Phone:301-528-2810
Practice Address - Fax:301-528-2811
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074724208VP0014X, 208VP0014X
MDD74724208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine