1487139424 NPI number — MR. PABLO F. RESTREPO PA-C/MPH

Table of content: MR. PABLO F. RESTREPO PA-C/MPH (NPI 1487139424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487139424 NPI number — MR. PABLO F. RESTREPO PA-C/MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RESTREPO
Provider First Name:
PABLO
Provider Middle Name:
F.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C/MPH
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:
1487139424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
JOHNS HOPKINS BAYVIEW MEDICAL CENTER
Provider Second Line Business Mailing Address:
4950 EASTERN AVE / BLDG A - 6TH FLOOR
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-550-0101
Provider Business Mailing Address Fax Number:
410-367-3278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JOHNS HOPKINS BAYVIEW MEDICAL CENTER
Provider Second Line Business Practice Location Address:
4950 EASTERN AVE / BLDG A - 6TH FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-550-0101
Provider Business Practice Location Address Fax Number:
410-367-3278
Provider Enumeration Date:
09/25/2018

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: 363AS0400X , with the licence number:  C0008490 , 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)

  • Identifier: 112500300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com