Provider Demographics
NPI:1417069006
Name:ZALDUONDO, ALFONSO P (MD)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:P
Last Name:ZALDUONDO
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 1:7600 OSLER DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7735
Mailing Address - Country:US
Mailing Address - Phone:410-296-3092
Mailing Address - Fax:410-494-6442
Practice Address - Street 1:7600 OSLER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7735
Practice Address - Country:US
Practice Address - Phone:410-296-3092
Practice Address - Fax:410-494-6442
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29306208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD473921300OtherMEDICAL ASSISTANCE
GAP00931598OtherRAILROAD MEDICARE
MD207118YDXHOtherMEDICARE
DCX743 0001OtherCAREFIRST
MD42308606OtherCAREFIRST
MD207118YDXHOtherMEDICARE