1750376406 NPI number — DR. MARCO ANTONIO CORCHADO BARRETO M.D.

Table of content: DR. MARCO ANTONIO CORCHADO BARRETO M.D. (NPI 1750376406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750376406 NPI number — DR. MARCO ANTONIO CORCHADO BARRETO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORCHADO BARRETO
Provider First Name:
MARCO
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1750376406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1039
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-872-8313
Provider Business Mailing Address Fax Number:
787-872-8313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7260 AVE AGUSTIN RAMOS CALERO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662-3592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-872-8313
Provider Business Practice Location Address Fax Number:
787-872-8313
Provider Enumeration Date:
09/19/2005

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: 207QA0505X , with the licence number:  12847 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100100W . This is a "MMM HEALTHCARE, INC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6620108 . This is a "HUMANA HEALTH PLANS OF PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20792CO . This is a "TRIPLE S, INC." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PE-4617 . This is a "PANAMERICAN LIFE INS COMP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 115-12847 . This is a "GLOBAL HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 200332 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9003753 . This is a "LA CRUZ AZUL DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com