Provider Demographics
NPI:1578537254
Name:ALVAREZ, CONSUELO M (MD)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:M
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WEBSTER STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:603-663-7030
Mailing Address - Fax:603-663-7039
Practice Address - Street 1:138 WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-663-7030
Practice Address - Fax:603-663-7039
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12831207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1072487OtherAETNA PIN
NH30205377Medicaid
NH494238OtherTUFTS PIN
NHE44760OtherANTHEM REFERRING UPIN
NHE44760OtherHARVARD PILGRIM PIN
NH01YP08629NH01OtherANTHEM BCBS PIN
NH9711297OtherCIGNA PIN
NH1072487OtherAETNA PIN
NHE44760OtherANTHEM REFERRING UPIN