Provider Demographics
NPI:1578530333
Name:ALVARADO, CRISTOBAL G (MD)
Entity Type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:G
Last Name:ALVARADO
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 1:455 LEWIS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-634-1900
Mailing Address - Fax:203-237-8441
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-634-1900
Practice Address - Fax:203-237-8441
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007299208600000X
ME018306208G00000X, 208600000X, 2086S0129X
MEMD18306208G00000X, 2086S0129X, 208600000X
CT051650208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434425499Medicaid
DEP00174912OtherRAILROAD MEDICARE
CT008044322Medicaid
DE1000036126Medicaid
DEP00174912OtherRAILROAD MEDICARE
H29581Medicare UPIN
ME434425499Medicaid
MEH29581Medicare UPIN
014932S72Medicare ID - Type Unspecified
DE1000036126Medicaid
CTD400086881Medicare PIN