Provider Demographics
NPI:1447573076
Name:ALBERTO RENE MALDONADO, M.D., P.S.C.
Entity Type:Organization
Organization Name:ALBERTO RENE MALDONADO, M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-456-9214
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE 3337
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-456-9214
Mailing Address - Fax:502-458-9348
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:SUITE 3337
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-456-9214
Practice Address - Fax:502-458-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049333OtherANTHEM
KY240007602OtherPALMETTOGBA
KY2432718000OtherPASSPORT ADVANTAGE
KYK005255OtherCHAMPUS
KY100014410AOtherMEDICAID OF INDIANA
KY64211063Medicaid
KY1049929OtherPASSPORT HEALTH PLAN
KYC24484Medicare UPIN
KY000000049333OtherANTHEM