Provider Demographics
NPI:1194894808
Name:MALDONADO, ALBERTO RENE (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:RENE
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 NICKLEBY WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4077
Mailing Address - Country:US
Mailing Address - Phone:502-636-9949
Mailing Address - Fax:502-636-9546
Practice Address - Street 1:516 NICKLEBY WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4077
Practice Address - Country:US
Practice Address - Phone:502-636-9949
Practice Address - Fax:502-636-9546
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64211063Medicaid
KY1423101Medicare PIN
KY64211063Medicaid