1851385603 NPI number — DR. ERNESTO RIVERA MD

Table of content: DR. ERNESTO RIVERA MD (NPI 1851385603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851385603 NPI number — DR. ERNESTO RIVERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
ERNESTO
Provider Middle Name:
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:
RIVERA
Provider Other First Name:
ERNESTO
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851385603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 SINCLAIR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21213-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-732-8800
Provider Business Mailing Address Fax Number:
410-534-2392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 FLEET ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-558-4900
Provider Business Practice Location Address Fax Number:
410-522-5070
Provider Enumeration Date:
09/08/2005

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: 207V00000X , with the licence number:  D18554 , 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: 118131900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1050001 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07124 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6774E . This is a "CAREFIRST BLUE SHIELD MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 21536 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".




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