Provider Demographics
NPI:1073795613
Name:ECHEVERRI, ROBERTO JULIO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:JULIO
Last Name:ECHEVERRI
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 1:1000 E EAGER ST
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5533
Mailing Address - Country:US
Mailing Address - Phone:410-502-8379
Mailing Address - Fax:410-522-5138
Practice Address - Street 1:1000 E EAGER ST
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5533
Practice Address - Country:US
Practice Address - Phone:410-502-8379
Practice Address - Fax:410-522-5138
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102302207Q00000X
MDD0066596207Q00000X
MDP19554390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414795200Medicaid