Provider Demographics
NPI:1356505291
Name:URDANETA, ALFREDO I (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:I
Last Name:URDANETA
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:PO BOX 980058
Mailing Address - Street 2:RONC: RADIATION ONCOLOGY
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0058
Mailing Address - Country:US
Mailing Address - Phone:804-828-7238
Mailing Address - Fax:
Practice Address - Street 1:401 COLLEGE ST
Practice Address - Street 2:RONC: RADIATION ONCOLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5017
Practice Address - Country:US
Practice Address - Phone:804-828-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0116022444390200000X
VA01012563042085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program