Provider Demographics
NPI:1154517399
Name:DRS. ACCINELLI, ALARCON, P.A.
Entity type:Organization
Organization Name:DRS. ACCINELLI, ALARCON, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALARCON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-766-5656
Mailing Address - Street 1:325 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5807
Mailing Address - Country:US
Mailing Address - Phone:410-766-5656
Mailing Address - Fax:410-766-6919
Practice Address - Street 1:325 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5807
Practice Address - Country:US
Practice Address - Phone:410-766-5656
Practice Address - Fax:410-766-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD000024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD911541200Medicaid
MD911541200Medicaid