Healthcare Provider Details

I. General information

NPI: 1104854108
Provider Name (Legal Business Name): ALVIN SANICO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 N CHARLES ST PPN 200
TOWSON MD
21204-5826
US

IV. Provider business mailing address

6535 N CHARLES ST PPN 200
TOWSON MD
21204-5826
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-8393
  • Fax: 410-583-8394
Mailing address:
  • Phone: 410-583-8393
  • Fax: 410-583-8394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberD46370
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: