1760415293 NPI number — DR. GLORIA FUENTES M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760415293 NPI number — DR. GLORIA FUENTES M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FUENTES

Provider First Name:

GLORIA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1760415293

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/23/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1829 REISTERSTOWN RD

Provider Second Line Business Mailing Address:

SUITE 205

Provider Business Mailing Address City Name:

BALTIMORE

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21208-6320

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-602-9842

Provider Business Mailing Address Fax Number:

410-602-9857

Provider First Line Business Practice Location Address:

4 W ROLLING CROSSROADS

Provider Second Line Business Practice Location Address:

SUITE 100

Provider Business Practice Location Address City Name:

BALTIMORE

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21228-6280

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-869-0100

Provider Business Practice Location Address Fax Number:

410-869-0460

Provider Enumeration Date:

07/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  D0033157 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0028 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
• Identifier: 2328095 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 012335 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 35168804 . This is a "CAREFIRST MARYLAND" identifier . This identifiers is of the category "OTHER".
• Identifier: 700904 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 7090097 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 281932 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 9974 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
• Identifier: 1203593 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 435681100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 110155 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
• Identifier: 1981791 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 93130 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 6763604 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".