Provider Demographics
NPI:1851744999
Name:ALVARE, TYLER JENNINGS (PA-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JENNINGS
Last Name:ALVARE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 CACTUS HILL RD
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-9681
Mailing Address - Country:US
Mailing Address - Phone:267-885-4712
Mailing Address - Fax:
Practice Address - Street 1:9550 LIVINGSTON RD STE 102
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4975
Practice Address - Country:US
Practice Address - Phone:240-253-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005442363AM0700X
MDC0009216363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical