1679065270 NPI number — ERIC JOSEPH MALDONADO MARRERO MD

Table of content: ERIC JOSEPH MALDONADO MARRERO MD (NPI 1679065270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679065270 NPI number — ERIC JOSEPH MALDONADO MARRERO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALDONADO MARRERO
Provider First Name:
ERIC
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
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:
1679065270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FLORIDA ATLANTIC UNIVERSITY VASCULAR SURGERY FELLOWSHIP
Provider Second Line Business Mailing Address:
5352 LINTON BLVD
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-637-5172
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DELRAY MEDICAL CENTER - FAIR OAKS PAVILION #258
Provider Second Line Business Practice Location Address:
5352 LINTON BLVD
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-637-5172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2018

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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