Healthcare Provider Details

I. General information

NPI: 1841261021
Provider Name (Legal Business Name): MANUEL ALVARADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 E MAIN ST
LEESBURG FL
34748-5329
US

IV. Provider business mailing address

1414 E MAIN ST
LEESBURG FL
34748-5329
US

V. Phone/Fax

Practice location:
  • Phone: 352-728-3898
  • Fax: 352-728-6240
Mailing address:
  • Phone: 352-728-3898
  • Fax: 352-728-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME-0059124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: