Provider Demographics
NPI:1528072261
Name:OLIVARES, ALVARO JOSE (MD)
Entity type:Individual
Prefix:
First Name:ALVARO
Middle Name:JOSE
Last Name:OLIVARES
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 1:455 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-455-6293
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6200
Practice Address - Fax:401-455-6293
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD093972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007060210OtherMEDICARE ID-TYPE UNSPECIFIED
RI9025295Medicaid
1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RI1104801349OtherBUTLER HOSPITAL NPI
RI15-49995OtherUNITED BEHAVIORAL HEALTH
RI007060210OtherMEDICARE ID-TYPE UNSPECIFIED
RI9025295Medicaid