Provider Demographics
NPI:1639198880
Name:PEREIRA-RICO, ALVARO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:
Last Name:PEREIRA-RICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALVARO
Other - Middle Name:
Other - Last Name:RICO PEREIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-4000
Mailing Address - Fax:215-707-5066
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-4000
Practice Address - Fax:215-707-5066
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418937207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001904596Medicaid
NJ8892202Medicaid
PA001904596Medicaid