Basic Information
Provider Information
NPI: 1215140686
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHIRINOS
FirstName: JULIO
MiddleName: ALONSO
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CHIRINOS MEDINA
OtherFirstName: JULIO
OtherMiddleName: ALONSO
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 2
Mailing Information
Address1: 3400 CIVIC CENTER BLVD
Address2: EAST PAVILION, 2ND FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191045127
CountryCode: US
TelephoneNumber: 2156154949
FaxNumber:  
Practice Location
Address1: 3400 CIVIC CENTER BOULEVARD
Address2: EAST PAVILION, 2ND FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191044306
CountryCode: US
TelephoneNumber: 2156154949
FaxNumber: 2156150829
Other Information
ProviderEnumerationDate: 05/08/2007
LastUpdateDate: 11/12/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XMD431635PAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


Home