MEDICARE: LUZ FABIOLA ALVAREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	168586	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487631719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ FABIOLA ALVAREZ M.D.

Provider Business Mailing Address
First Line	:	99 E STATE ST
Second Line	:	PO BOX 1250
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1203
Country	:	US
Telephone Number	:	518-775-4205
Fax Number	:	518-775-4225

Provider Business Practice Location Address
First Line	:	434 S KINGSBORO AVE
Second Line	:
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3822
Country	:	US
Telephone Number	:	518-752-5275
Fax Number	:	518-752-5277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	01/22/2015

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