Provider Demographics
NPI:1437129202
Name:ALEGRE - IPANAG, OLIVIA Y (MD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:Y
Last Name:ALEGRE - IPANAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 EFFINGHAM ST STE 302
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3464
Mailing Address - Country:US
Mailing Address - Phone:757-673-6277
Mailing Address - Fax:757-673-6411
Practice Address - Street 1:446 EFFINGHAM ST.
Practice Address - Street 2:STE 302
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4818
Practice Address - Country:US
Practice Address - Phone:757-673-6277
Practice Address - Fax:757-673-6411
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G73104Medicare UPIN