Provider Demographics
NPI:1548240575
Name:GOMES, ALVARO (RPA C)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:GOMES
Suffix:
Gender:M
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 RANDOLPH RD
Mailing Address - Street 2:STE 303
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5122
Mailing Address - Country:US
Mailing Address - Phone:704-333-0463
Mailing Address - Fax:704-333-0466
Practice Address - Street 1:49 FOREST RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:845-782-3242
Practice Address - Fax:845-783-7133
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008391 1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q10353Medicare UPIN