Provider Demographics
NPI:1750352555
Name:ALONSO, ADOLFO M (MD PA)
Entity type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:M
Last Name:ALONSO
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:A.
Other - Middle Name:MILLER
Other - Last Name:ALONSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11121 YORK RD
Mailing Address - Street 2:STE 2
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2006
Mailing Address - Country:US
Mailing Address - Phone:410-560-5880
Mailing Address - Fax:410-560-5888
Practice Address - Street 1:11121 YORK RD STE 2
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2006
Practice Address - Country:US
Practice Address - Phone:410-560-5880
Practice Address - Fax:410-560-5888
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016346174400000X
MDD163462082S0099X, 2086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD77601Medicare UPIN