Modesto S Rivera Iii Md Pa | |
806 Solomons Island Rd N Prnc Frederck MD 20678-3919 | |
(410) 535-3424 | |
(410) 535-4983 |
Full Name | Modesto S Rivera Iii Md Pa |
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Speciality | Clinic/center |
Location | 806 Solomons Island Rd N, Prnc Frederck, Maryland |
Authorized Official Name and Position | Modesto Santos Rivera (PRESIDENT) |
Authorized Official Contact | 4105354242 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Modesto S Rivera Iii Md Pa 806 Solomons Island Rd N Prnc Frederck MD 20678-3919 Ph: (410) 535-3424 | Modesto S Rivera Iii Md Pa 806 Solomons Island Rd N Prnc Frederck MD 20678-3919 Ph: (410) 535-3424 |
NPI Number | 1922325026 |
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Provider Enumeration Date | 04/28/2010 |
Last Update Date | 04/28/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922325026 | NPI | - | NPPES |
0283 | Other | GHMSI | |
2122218 | Other | MAMSI | |
1887319 00 | Medicaid | MD | |
34888001 | Other | MD | BLUE SHIELD CAREFIRST |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | D19963 (Maryland) | Primary |