# ALBERTO RENE MALDONADO, M.D., P.S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447573076
- **Authorized official:** DR. ALBERTO RENE MALDONADO M.D. (PRESIDENT)
- **Authorized official phone:** (502) 456-9214

## Contact information

- **Practice address:** 1169 EASTERN PKWY, SUITE 3337, LOUISVILLE, KY 40217-1417
- **Practice address phone:** (502) 456-9214
- **Practice address fax:** (502) 458-9348
- **Mailing address:** 1169 EASTERN PKWY, SUITE 3337, LOUISVILLE, KY 40217-1417
- **Mailing address phone:** (502) 456-9214
- **Mailing address fax:** (502) 458-9348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 21106 | KY | Yes |

## Other

- **Enumeration date:** 03/10/2010
- **Last updated:** 03/10/2010

## 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 |