Provider Demographics
NPI:1992773600
Name:ALVARADO, MARCIO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIO
Middle Name:ANTONIO
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCIO
Other - Middle Name:ANTONIO
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1806
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-0806
Mailing Address - Country:US
Mailing Address - Phone:703-998-1112
Mailing Address - Fax:
Practice Address - Street 1:5268 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1404
Practice Address - Country:US
Practice Address - Phone:703-998-1112
Practice Address - Fax:703-998-1113
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037854174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE96418Medicare UPIN
VA638328Medicare ID - Type Unspecified