Provider Demographics
NPI:1508992553
Name:ALVARO N. CHANGCO, M.D., INC.
Entity Type:Organization
Organization Name:ALVARO N. CHANGCO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-945-6128
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:COKEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15324-0232
Mailing Address - Country:US
Mailing Address - Phone:724-945-6128
Mailing Address - Fax:724-945-6252
Practice Address - Street 1:#14 ROUTE 917
Practice Address - Street 2:
Practice Address - City:COKEBURG
Practice Address - State:PA
Practice Address - Zip Code:15324
Practice Address - Country:US
Practice Address - Phone:724-945-6128
Practice Address - Fax:724-945-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035890L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1937559OtherBLUE SHIELD
PA109919Medicare PIN
PAB40726Medicare UPIN