Provider Demographics
NPI:1174528533
Name:ALVEAR, DOMINGO T (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:T
Last Name:ALVEAR
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 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 WALNUT ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1168
Practice Address - Country:US
Practice Address - Phone:717-232-9593
Practice Address - Fax:717-234-9638
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033698L2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAL128403OtherBLUE SHIELD
PA0006399930005Medicaid
PA01605301OtherBLUE CROSS
PA0006399930001Medicaid
PA0006399930001Medicaid
PA0639993Medicare ID - Type Unspecified
PAC31053Medicare UPIN