1811214703 NPI number — DR. CHARINA CECILLE REYES M.D.

Table of content: DR. CHARINA CECILLE REYES M.D. (NPI 1811214703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811214703 NPI number — DR. CHARINA CECILLE REYES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
CHARINA CECILLE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811214703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-2063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-706-5181
Provider Business Mailing Address Fax Number:
410-706-5103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7556 TEAGUE RD
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21076-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-755-0681
Provider Business Practice Location Address Fax Number:
443-755-0685
Provider Enumeration Date:
05/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  D82205 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0006X , with the licence number: D82205 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com