Healthcare Provider Details

I. General information

NPI: 1578530333
Provider Name (Legal Business Name): CRISTOBAL G ALVARADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE SUITE 203
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

455 LEWIS AVE SUITE 203
MERIDEN CT
06451-2121
US

V. Phone/Fax

Practice location:
  • Phone: 203-634-1900
  • Fax: 203-237-8441
Mailing address:
  • Phone: 203-634-1900
  • Fax: 203-237-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0007299
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number018306
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number018306
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number018306
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD18306
License Number StateME
# 6
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD18306
License Number StateME
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD18306
License Number StateME
# 8
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number051650
License Number StateCT
# 9
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number051650
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: