Provider Demographics
NPI:1437224656
Name:ALEGADO, ELI BALADAD (MD)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:BALADAD
Last Name:ALEGADO
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 1:4115 RITCHIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225
Mailing Address - Country:US
Mailing Address - Phone:410-609-0041
Mailing Address - Fax:410-609-0165
Practice Address - Street 1:4115 RITCHIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225
Practice Address - Country:US
Practice Address - Phone:410-609-0041
Practice Address - Fax:410-609-0165
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42041207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD343921600Medicaid
G04756Medicare UPIN
276QMedicare ID - Type Unspecified