Provider Demographics
NPI:1356653711
Name:GUO, ALICE (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:GUO
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:3411 WAYNE AVE
Mailing Address - Street 2:DIVISION OF GERIATRICS, 2ND FL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2509
Mailing Address - Country:US
Mailing Address - Phone:718-920-6722
Mailing Address - Fax:718-655-9672
Practice Address - Street 1:3400 BAINBRIDGE AVE
Practice Address - Street 2:DIVISION OF GERIATRICS, 2ND FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:866-663-8255
Practice Address - Fax:718-655-9672
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2020-12-30
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Provider Licenses
StateLicense IDTaxonomies
NY275031207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03892793Medicaid
NYA400105266Medicare PIN