Healthcare Provider Details

I. General information

NPI: 1174528533
Provider Name (Legal Business Name): DOMINGO T ALVEAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WALNUT ST
LEMOYNE PA
17043-1168
US

IV. Provider business mailing address

409 S 2ND ST SUITE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-232-9593
  • Fax: 717-234-9638
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD033698L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: