Provider Demographics
NPI:1548294655
Name:ALFANO, MARY ALICE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALICE
Last Name:ALFANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SHAFER CT STE 700
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4989
Mailing Address - Country:US
Mailing Address - Phone:346-376-1702
Mailing Address - Fax:224-532-2780
Practice Address - Street 1:3451 BENNING RD NE STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1504
Practice Address - Country:US
Practice Address - Phone:909-605-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD90758207QH0002X
FLME109017207QH0002X
DCMD210002503207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA1954026OtherDEA
FLME109017OtherM.D. LICENSE
FL14C0SOtherBCBS
NYP00249050OtherRAILROAD MEDICARE
FLP01349707OtherRAILROAD MEDICARE
FL003292500Medicaid