Provider Demographics
NPI:1922155118
Name:ALVAREZ, MIGUEL A S (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A S
Last Name:ALVAREZ
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 1:215 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1509
Mailing Address - Country:US
Mailing Address - Phone:631-477-4214
Mailing Address - Fax:631-477-1992
Practice Address - Street 1:215 6TH AVE
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1509
Practice Address - Country:US
Practice Address - Phone:631-477-4214
Practice Address - Fax:631-477-1992
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1377612084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00421536Medicaid
NY00421536Medicaid
NY67A751Medicare PIN