Provider Demographics
NPI:1801465166
Name:GUILLEN ALVAREZ, IAN FERNANDO (MD)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:FERNANDO
Last Name:GUILLEN 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 1:2800 MAIN STREET
Mailing Address - Street 2:DEPT OF MEDICINE
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 MAIN STREET
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:475-210-5791
Practice Address - Fax:475-210-5022
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT76275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program