Provider Demographics
NPI:1427565217
Name:IBASETA FIDALGO, ALVARO (MS)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:IBASETA FIDALGO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 N BROADWAY STE 147
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1832
Mailing Address - Country:US
Mailing Address - Phone:410-955-3080
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC 9500 EUCLID AVENUE/NA-23
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0005
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program