Provider Demographics
NPI:1447209614
Name:LARRIEU, ALBERTO J (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:J
Last Name:LARRIEU
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 1:1200 BUSTLETON PIKE STE 7
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4108
Mailing Address - Country:US
Mailing Address - Phone:267-288-5060
Mailing Address - Fax:
Practice Address - Street 1:1200 BUSTLETON PIKE STE 7
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4108
Practice Address - Country:US
Practice Address - Phone:267-288-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025835E207Q00000X, 207R00000X
PAMD-025835-E208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA930093851OtherRAILROAD MEDICARE
PA0008205170001Medicaid
PA416156OtherHIGHMARK BS
PA416156Medicare PIN
PA0008205170001Medicaid