Provider Demographics
NPI:1629138748
Name:LUIS ALONSO MD PC
Entity Type:Organization
Organization Name:LUIS ALONSO MD PC
Other - Org Name:PEDIATRIC & ADOLESCENT MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONCATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-294-6328
Mailing Address - Street 1:1062 BARNES RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-6012
Mailing Address - Country:US
Mailing Address - Phone:203-294-6328
Mailing Address - Fax:203-294-6346
Practice Address - Street 1:1062 BARNES RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-6012
Practice Address - Country:US
Practice Address - Phone:203-294-6328
Practice Address - Fax:203-294-6346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty