Provider Demographics
NPI:1063709046
Name:ALVAREZ PICHARDO, ELAINE MABEL (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MABEL
Last Name:ALVAREZ PICHARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-7697
Mailing Address - Country:US
Mailing Address - Phone:270-901-0629
Mailing Address - Fax:270-901-0892
Practice Address - Street 1:1901 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3303
Practice Address - Country:US
Practice Address - Phone:270-901-0629
Practice Address - Fax:270-901-0892
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57014840207R00000X
KY47687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine