Provider Demographics
NPI:1740210889
Name:ALISUAG, RESTITUTO M (MD)
Entity Type:Individual
Prefix:
First Name:RESTITUTO
Middle Name:M
Last Name:ALISUAG
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:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-612-4323
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4088
Practice Address - Fax:215-612-4323
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033694L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0153177OtherCIGNA
PA00741010-04OtherAMERICHOICE
PA118863OtherPERSONAL CHOICE
PA0007410100006Medicaid
PA050090904OtherRAILROAD MEDICARE
PA30563 - FRANKFORDOtherHEALTH PARTNERS
PA01697 - TORRESDALEOtherHEALTH PARTNERS
PA0007410100004Medicaid
PA0056847000OtherKEYSTONE, IBC
PA118863OtherHIGHMARK BLUE SHIELD
PA30002947OtherKEYSTONE MERCY
PA3056444OtherAETNA CONTRACT NUMBER
PA96654OtherUNITED
PA30563 - FRANKFORDOtherHEALTH PARTNERS
PA0007410100004Medicaid