Provider Demographics
NPI:1023031986
Name:ALICEA, A ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:ALBERT
Last Name:ALICEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1780
Mailing Address - Country:US
Mailing Address - Phone:610-838-1010
Mailing Address - Fax:610-838-6285
Practice Address - Street 1:255 FRONT ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1780
Practice Address - Country:US
Practice Address - Phone:610-838-1010
Practice Address - Fax:610-838-6285
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048597L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF36398Medicare UPIN
PA688456Medicare PIN