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Organization
ALBERTO RENE MALDONADO, M.D., P.S.C.
Active
Organization
ALBERTO RENE MALDONADO, M.D., P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBERTO RENE MALDONADO M.D. (PRESIDENT)
(502) 456-9214
Entity
Organization
Contact information
Practice address
1169 EASTERN PKWY, SUITE 3337, LOUISVILLE, KY 40217-1417
(502) 456-9214
(502) 458-9348
Mailing address
1169 EASTERN PKWY, SUITE 3337, LOUISVILLE, KY 40217-1417
(502) 456-9214
(502) 458-9348
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21106
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000049333
ANTHEM
KY
01
—
100014410A
MEDICAID OF INDIANA
KY
01
—
1049929
PASSPORT HEALTH PLAN
KY
01
—
240007602
PALMETTOGBA
KY
01
—
2432718000
PASSPORT ADVANTAGE
KY
05
—
64211063
—
KY
01
—
K005255
CHAMPUS
KY
Enumeration date
03/10/2010
Last updated
03/10/2010
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