Provider Demographics
NPI:1104861434
Name:ALVINO, PATRICK M (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:ALVINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:784 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2918
Mailing Address - Country:US
Mailing Address - Phone:203-481-7008
Mailing Address - Fax:203-315-2712
Practice Address - Street 1:784 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2918
Practice Address - Country:US
Practice Address - Phone:203-481-7008
Practice Address - Fax:203-315-2712
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0268112080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001268110Medicaid
CT00461RMedicare UPIN