Provider Demographics
NPI:1871505628
Name:SECO, ALFREDO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:JOSE
Last Name:SECO
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 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-8960
Practice Address - Street 1:370 28TH ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1789
Practice Address - Country:US
Practice Address - Phone:740-676-2819
Practice Address - Fax:740-676-2852
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051259208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0128678000Medicaid
OH0583588Medicaid
930023204OtherRAILROAD MEDICARE
930023204OtherRAILROAD MEDICARE