Provider Demographics
NPI:1104854108
Name:SANICO, ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:SANICO
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 1:6535 N CHARLES ST
Mailing Address - Street 2:PPN 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5826
Mailing Address - Country:US
Mailing Address - Phone:410-583-8393
Mailing Address - Fax:410-583-8394
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:PPN 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:410-583-8393
Practice Address - Fax:410-583-8394
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46370207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD841101800Medicaid
MDKR63267WMedicare ID - Type Unspecified
MD841101800Medicaid