1982652111 NPI number — DR. MARY T CHACON CRESPO M.D.

Table of content: DR. MARY T CHACON CRESPO M.D. (NPI 1982652111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982652111 NPI number — DR. MARY T CHACON CRESPO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHACON CRESPO
Provider First Name:
MARY
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1982652111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1806
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-224-0261
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. MAMEYAL 698
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-224-0261
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2006

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: 208D00000X , with the licence number:  15730 , 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)

  • Identifier: I36878 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com