Provider Demographics
NPI:1003842808
Name:TORRES, MICHAEL ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDRE
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 WYNDHURST AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2489
Mailing Address - Country:US
Mailing Address - Phone:410-617-0605
Mailing Address - Fax:443-773-1406
Practice Address - Street 1:600 WYNDHURST AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2489
Practice Address - Country:US
Practice Address - Phone:410-617-0605
Practice Address - Fax:443-773-1406
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD423822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212150600Medicaid
F26356Medicare UPIN