Healthcare Provider Details

I. General information

NPI: 1699114850
Provider Name (Legal Business Name): ALFREDO LLOREDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 TROY-SCHENECTADY ROAD SUITE 201
LATHAM NY
12110
US

IV. Provider business mailing address

1072 TROY-SCHENECTADY ROAD SUITE 201
LATHAM NY
12110
US

V. Phone/Fax

Practice location:
  • Phone: 518-786-7000
  • Fax: 518-786-1160
Mailing address:
  • Phone: 518-786-7000
  • Fax: 518-786-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number311273-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number256937
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: