1558357301 NPI number — DR. BERNARDO J MARQUES MD

Table of content: DR. BERNARDO J MARQUES MD (NPI 1558357301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558357301 NPI number — DR. BERNARDO J MARQUES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARQUES
Provider First Name:
BERNARDO
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1558357301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 AVE ORTEGON
Provider Second Line Business Mailing Address:
APT. 1602, CONDOMINIO PLAZA ATENS
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-783-8908
Provider Business Mailing Address Fax Number:
787-780-2121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 ROAD 2
Provider Second Line Business Practice Location Address:
CT RADIOLOGY COMPLEX BLDG
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00960-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-780-9069
Provider Business Practice Location Address Fax Number:
787-780-9069
Provider Enumeration Date:
09/26/2005

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: 2085R0202X , with the licence number:  2959 , 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)





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