Provider Demographics
NPI:1871054593
Name:ALVAREZ, MARCELINO (SUBMARINE IDC)
Entity type:Individual
Prefix:
First Name:MARCELINO
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:SUBMARINE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2521
Mailing Address - Country:US
Mailing Address - Phone:956-407-7172
Mailing Address - Fax:
Practice Address - Street 1:USS MONTPELIER
Practice Address - Street 2:SSN 765
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-694-2876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman