Provider Demographics
NPI:1003122235
Name:VALENZUELA CANEPA, PERCY IVAN (MD)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:IVAN
Last Name:VALENZUELA CANEPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 FRANKLIN SQUARE DR
Mailing Address - Street 2:HOSPITALIST PROGRAM
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3901
Mailing Address - Country:US
Mailing Address - Phone:443-777-8186
Mailing Address - Fax:443-777-7159
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-8186
Practice Address - Fax:443-777-7159
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0075541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program