Provider Demographics
NPI:1699874602
Name:ALVARADO, TERESA LOIS (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LOIS
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 STATION STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-455-5000
Mailing Address - Fax:910-455-7083
Practice Address - Street 1:219 STATION STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-455-5000
Practice Address - Fax:910-455-7083
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30273207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561940600OtherTAX ID
NC8910996Medicaid
D62768Medicare UPIN
NC561940600OtherTAX ID