Provider Demographics
NPI:1538151683
Name:AREVALO, ALFONSO SEGUNDO (MD)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:SEGUNDO
Last Name:AREVALO
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 1:105 WESTPOINT DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5928
Mailing Address - Country:US
Mailing Address - Phone:724-836-6041
Mailing Address - Fax:724-836-0959
Practice Address - Street 1:105 WESTPOINT DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5928
Practice Address - Country:US
Practice Address - Phone:724-836-6041
Practice Address - Fax:724-836-0959
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045751L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine