Provider Demographics
NPI:1770337123
Name:ALVARADO, ED WONG (MD)
Entity type:Individual
Prefix:
First Name:ED
Middle Name:WONG
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ED
Other - Middle Name:W
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:529 S JACKSON ST FL 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3229
Mailing Address - Country:US
Mailing Address - Phone:502-852-9566
Mailing Address - Fax:
Practice Address - Street 1:529 S JACKSON ST FL 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3229
Practice Address - Country:US
Practice Address - Phone:502-852-9566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program