Provider Demographics
NPI:1386623957
Name:PADILLA, ALFRED J (MD,)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:J
Last Name:PADILLA
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 1:56 LAFAYETTE PL
Mailing Address - Street 2:# A
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5430
Mailing Address - Country:US
Mailing Address - Phone:914-273-8546
Mailing Address - Fax:
Practice Address - Street 1:56 LAFAYETTE PL
Practice Address - Street 2:STE A
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5430
Practice Address - Country:US
Practice Address - Phone:203-622-9160
Practice Address - Fax:203-661-3887
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023697174400000X
CT23697207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT07D0930087OtherCLIA NUMBER
CT1236975Medicaid
CT023697OtherCONNECTICUT LINCENSE #
CT010023697 CT 01OtherBLUE CROSS& BLUE SHIELD #
CTAP8883123OtherDEA NUMBER
CTAP8883123OtherDEA NUMBER
CT1236975Medicaid
CTAP8883123OtherDEA NUMBER