Provider Demographics
NPI:1023257698
Name:ADOLFO M ALONSO MD PA
Entity type:Organization
Organization Name:ADOLFO M ALONSO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:410-644-5400
Mailing Address - Street 1:3449 WILKENS AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5281
Mailing Address - Country:US
Mailing Address - Phone:410-644-5400
Mailing Address - Fax:410-644-8862
Practice Address - Street 1:3449 WILKENS AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5281
Practice Address - Country:US
Practice Address - Phone:410-644-5400
Practice Address - Fax:410-644-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD16346174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD453LMedicare PIN
MDD77601Medicare UPIN