Basic Information
Provider Information
NPI: 1548294655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALFANO-TORRES
FirstName: MARY
MiddleName: ALICE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6400 SHAFER CT STE 700
Address2:  
City: ROSEMONT
State: IL
PostalCode: 600184989
CountryCode: US
TelephoneNumber: 3463761702
FaxNumber: 2245322780
Practice Location
Address1: 5457 TWIN KNOLLS RD STE 100
Address2:  
City: COLUMBIA
State: MD
PostalCode: 210453263
CountryCode: US
TelephoneNumber: 4106897400
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/11/2006
LastUpdateDate: 03/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QH0002XME109017FLY Allopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine

No ID Information.


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